Term
| definiton of HF based on symptoms: |
|
Definition
| dyspnea and fatigue by ABNORMAL cardiac functions |
|
|
Term
| definition of HF based on function |
|
Definition
| heart cannot pump efficiently to meet metabolic demands |
|
|
Term
| how do you differentiate btwn systolic and diastolic HF |
|
Definition
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|
Term
| HF with preserved EF is common for what HF? |
|
Definition
|
|
Term
LVH- left ventricular hypertrophy is common for what HF?
what other abnormality? |
|
Definition
diastolic
left ventricle stiffness |
|
|
Term
LVD- left ventricle dysfunction is common for what HF?
what other abnormality? |
|
Definition
systolic
dilated cardiomyopathy |
|
|
Term
| what are the causes of decreased cardiac output- 7 |
|
Definition
HTN
infectious disease
CAD
MI
Drugs
volume overload
idiopathic |
|
|
Term
what is the BIG compensaotry mechanism for a decreased cardiac output?
what is the other mechanism? |
|
Definition
increased SNS
RAS system activation |
|
|
Term
what does the activaiton of aldosterone do?
what does this increase? |
|
Definition
water and sodium retention
preload |
|
|
Term
SNS activation increases what directly-
it also constricts the veins and arteries, which increases afterload, and which does preload? |
|
Definition
HR
constriciton of veins does preload
arteries- afterload |
|
|
Term
what drug dilates the arteries?
whcih does venous side? |
|
Definition
|
|
Term
a major cause of death for HF patients is?
why? |
|
Definition
sudden arrythmia
too much stimulation and cant compensate |
|
|
Term
| an increase in afterload decrease what? |
|
Definition
|
|
Term
| which classificaiton system is based on symptoms? which is based on structure? |
|
Definition
|
|
Term
Stage for NYHA:
diagnosis of heart failure + no symtpoms |
|
Definition
|
|
Term
Stage for NYHA:
diagnosis of heart failure + symptoms that have a little limitation of acitvity, no symptoms at rest |
|
Definition
|
|
Term
Stage for NYHA:
diagnosis of heart failure + symptoms that restrict a lot of acitvity, no symptoms at rest |
|
Definition
|
|
Term
Stage for NYHA:
diagnosis of heart failure + symptoms at rest |
|
Definition
|
|
Term
Stage for ACC/AHA:
- patient at high risk?
- what are the things that put them at high risk--5 |
|
Definition
stage A
HTN, CAD/CVD, diabetes, obesity, metabolic syndrome |
|
|
Term
Stage for ACC/AHA:
- patient has strucutural heart diease but no symptoms of HF
- Examples: -3 |
|
Definition
Stage B
previous MI, left ventricle dysfunction, LVH |
|
|
Term
Stage for ACC/AHA:
- patient with strucutre problem + symptoms (current or PREVIOUS)
- Ex of symptoms: -3 |
|
Definition
Stage C
dyspnea, fatgue, reduced exercise tolerance |
|
|
Term
Stage for ACC/AHA:
- patient with refractory HF needing special interventions
-Ex: |
|
Definition
Stage D
patient on max therapy but still symptoms at rest |
|
|
Term
| what is the first thing to do in determining treatment? |
|
Definition
| what is the cause or factors |
|
|
Term
| what are 3 etiologies of HF |
|
Definition
drug adherence
medications
disease associated with HF |
|
|
Term
| what are 5 things that increase risk for HF |
|
Definition
smoking
HTN
no exercise
CAD/dyslipidemia
obesity |
|
|
Term
| when should you put a restriction on the exercise of patients |
|
Definition
| acute symtpoms of congestion (edema/hypervolemic) |
|
|
Term
| how should you adjust a HF patient's diet |
|
Definition
|
|
Term
| what testing can be done if you are not sure of the diagnosis for a patient with SOB |
|
Definition
|
|
Term
| what does elevated BNP show |
|
Definition
| need to remove water- diuresis and natruresis |
|
|
Term
therapeutic action in heart failure:
diuretics |
|
Definition
|
|
Term
therapeutic action in heart failure:
ACEi |
|
Definition
| decrease preload, decrease afterload, decrease neurohormone tone |
|
|
Term
therapeutic action in heart failure:
b-blocker |
|
Definition
decrease nuerohormone tone
decrease chronotrope |
|
|
Term
therapeutic action in heart failure:
digoxin |
|
Definition
| + ionotrope, decrease neurohormone tone |
|
|
Term
therapeutic action in heart failure:
hydralazine |
|
Definition
|
|
Term
therapeutic action in heart failure:
nitrates |
|
Definition
|
|
Term
therapeutic action in heart failure:
aldosterone antagonists |
|
Definition
| decrease preload, decrease nuerohormone, decrease myocard fibrosis |
|
|
Term
| diuretics are used to relieve what symtpom? |
|
Definition
|
|
Term
| what are sings of pulmonary edema- 2 |
|
Definition
inpsiratory crackeles
3rd heart sound |
|
|
Term
| what are signs of portal congestion-2 |
|
Definition
|
|
Term
| what do you use diuretic in combo with-2 |
|
Definition
| another drug + Na restriction |
|
|
Term
| what effects does diuretics have on morbidity/mortality |
|
Definition
|
|
Term
| when do you use thiazide diuretics? |
|
Definition
|
|
Term
| Loop diuretics given IV can do what |
|
Definition
|
|
Term
| if a patient has impaired renal function what diuretic do you give |
|
Definition
|
|
Term
| if patient has loop diuretic resistance what options are avilable-2 |
|
Definition
switch to diff loop
add thiazide
give IV bolus/ cont infusion |
|
|
Term
| what replacement do most patients taking loop diuretic receive |
|
Definition
|
|
Term
| what drugs decreases morbidity and mortality -4 |
|
Definition
ARBs
ACEi
B blockers
aldosterone antags |
|
|
Term
|
Definition
|
|
Term
what drugs are always indicated for reduced EF/ LVD-2?
what are they normally used together with? |
|
Definition
|
|
Term
| what drugs can be used as prevention for patients with a lot of risk factors for HF? |
|
Definition
|
|
Term
|
Definition
angioedema
hypotension
hyperkalemia
renal insuffienecy |
|
|
Term
| for which drugs do you monitor dry weight? |
|
Definition
|
|
Term
| which drug can make you feel worse before making you feel better? |
|
Definition
|
|
Term
| which drug causes an increase in BP |
|
Definition
|
|
Term
what type of HF do you use digoxin in?
what is the only time you can use it in the other type? |
|
Definition
systolic
if also have afib |
|
|
Term
| how long do you need to wait before checking digoxin levels? |
|
Definition
|
|
Term
| what are the two times to consider aldosterone antags- |
|
Definition
LVDF after MI
HFrEF in Class III-IV HF |
|
|
Term
Avoid aldosterone antags if Cr CL is below?
or K concentration is?
or Sr Cr > _ in men, _ in women |
|
Definition
|
|
Term
| when using aldosterone antags, what medicaiotn should you avoid taking |
|
Definition
|
|
Term
| whcih needs higher dose of hydralazine- HTN or HF |
|
Definition
|
|
Term
hydralalzine interferes with what progression?
nitrates effect what 2 things |
|
Definition
HF
decrease night dyspnea & improve exercise |
|
|
Term
| what type of Ca blockers do you not use? |
|
Definition
|
|
Term
how do you manage a patient with only diastolic dysfunction?
what are these? -4 |
|
Definition
treat risk factors to prevention systolic
-HTN, HR, dyslipidemia, CAD |
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