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34 Cards in this Set

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Primarily a clinical condition in which the heart is unable to meet the metabolic requirements of the body, typically manifested by fluid retention.
Congestive Heart Failure
% of Diastolic HF in total HF
30% .. maybe 50%
Dilated CMO:

Sys or Dia Dysfunction?
Systolic dysfunction
Normal systolic dysfunction
Abnormalities with diastolic relaxation and diastolic stiffness
Diastolic Dysfunction
High Output Failure, secondary to what extra-cardiac abnormalities?
Sepsis, Thyrotoxicosis, anemia, AV fistula, Beriberi, High metabolic (Paget’s)
Increased resistance to diastolic filling and reduced relaxation results in increase in ___?___ and subsequent pulmonary edema and right sided failure
LVEDP

(Diastolic dysfunction
)
Elevated ___?___ resulting in increased wedge pressure, capillary leak and pulmonary edema, also right side failure
LVEDP

(Systolic dysfunction (CMO)
)
_______lesions can result in increased filling pressures, volume overloaded heart
Regurgitant valvular lesions
________ lesions can cause reduced cardiac output, increased diastolic pressure, pulmonary edema
Stenotic lesions
Treatment modalities aimed towards improvement in these 4 parameters affecting Cardiac Performance
Heart rate
Contractility (Inotropism)
Preload (Filling pressure)
Afterload (Increased work on the heart)
High output states of CHF result in ______, _______, ________ with ________
increased C.O., subsequent fluid retention, and increased pulmonary perfusion with pulmonary edema
Starling mechanism:
Ideal ventricular stretch (__?__) optimizes cardiac performance
preload
What is caused by the following:

Increased lung stiffness to breathing
Interstitial water affects gas exchange
dyspnea
Drugs good to decrease preload?
diuretics, lasics, morphine
Drugs good to decrease afterload?
lisinopril, maybe beta blockers.
Morphine depresses the respiratory system, why is this good for HF pt?
Give small dose (4mg) and resp sys will be fine,
causes vasodilating effects
Congestive Heart Failure Clinical Manifestations
Dyspnea, Orthopnea, PND, Fatigue
Congestive Heart Failure Physical Findings
(Right sided)
Neck vein distention
Peripheral edema, usually lower extremity due to gravity
Hepatomegaly secondary to volume congestion
Pleural effusions due to volume overload, increased capillary pressure with cavity space secretions
Bilateral or right side effusion, rarely if ever isolated left side effusion
Ascites
Anasarca
Right side third heart sound, TR, RV heave
Congestive Heart Failure Physical Findings
(Left sided)
Pulmonary rales secondary to edema
Left side third heart sound
Congestive Heart Failure Physical Findings
(Reduced C.O.)
Pale, cool skin, peripheral cyanosis
Tachycardia, reduced blood pressure
Somnolence, mental confusion
Cheyne Stokes respiration
Why hear a Left side third heart sound in CHF?
MR
Lab results of CHF
Hyponatremia -Dilutional
Pre renal azotemia -Renal hypoperfusion
Elevated B natriuretic peptide -Excellent marker for acute CHF
BNP under 100. Is it HF?
Probably not.
ECG of CHF?
Nothing specific
Tachycardia, LVH, non specific changes
CXR of CHF?
Cardiomegaly
Interstitial, pulmonary edema
Pleural effusions
Echo findings of CHF?
No changes diagnostic of CHF but mechanism can be ascertained possibly

(Echo diagnoses cardiomyopathy)
Catheterization findings in CHF?
Swan Ganz: elevated PWP, decreased cardiac output in systolic dysfunction, hemodynamically significant pericardial, congenital, or valvular disease
Treatment of CHF
Oxygen
Fluid restriction
Bed rest
Blood pressure control
Upright bed position
Diuretics -Reduce both volume and preload
Nitrates, morphine -Preload reduction
ACE-I, ARB agents -Afterload reduction
Inotropes -Digitalis, less useful than previously thought
Dobutrex, milrinone, epinephrine, etc(Improve cardiac output)
Beta blockers
Intra-aortic Balloon Counterpulsation
Is Digoxin a good inotropic agent?
no

use dobutamine, primacore, or big gun epinephrine
probably the superior beta blocker in CHF
Carvedilol
What is the Beta blocker for severe acute CHF
None.

Do not use Beta blockers for sever CHF
Drug class used to Improve heart’s environmental mileau in acute CHF
Beta blockers
Congestive Heart Failure Treatment of Chronic CHF
(Systolic Dysfunction vs. Diastolic)
Syst dys: Salt, fluid restriction


Diastolic Dysfunction:
--Blood pressure control is paramount
--Salt, fluid restriction
Congestive Heart Failure Treatment of Chronic CHF

(pharm)
Pharmacologic Agents
ACE-I and ARB agents
Beta Blockers
Diuretics, not always
Digitalis, in refractory cases
Aldactone
Inhibitory to the affects of increased renin
Consider ICD (implanted cardiac defibrillator) since cause of death is mostly arrhythmic
Consider RCT (resynchronized cardiac therapy) especially in patients with LBBB to correct the dys-synergy inherent in this abnormal myocardial contractile condition