Term
| Symptoms of Heart Failure |
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Definition
| Dyspnea, fatigue, orthopnea, paroxsysmal noturnal dyspnea, exercise intolerance, tachypnea, cough, nocturia, hemoptysis, abdominal pain, anorexia |
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Term
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Definition
| Patients with cardiac disease but without limitations of physical activity. Ordinary physical activity does not cause undue fatigue, dyspnea, or palpitation. |
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Term
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Definition
| Patients with cardiac disease that results in slight limitations of physical activity. Ordinary physical activity results in fatigue, palpitaion, dyspnea, or agina |
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Term
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Definition
| Patients with cardiac disease that results in marked limitation of physical activity. Although patients are comfortable at rest, less-than-ordinary activity will lead to symptoms. |
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Term
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Definition
| Patients with cardiac disease that results in an inability to carry on physical activity without discomfort. Symptoms of CHF are present even at rest. With any physical activity, increased discomfort is experienced. |
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Term
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Definition
| Patient at high risk for developing heart failure. Ex: htn, cad or other atherosclerotic vascular disease, diabetes, obesity, metabolic syndrome |
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Term
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Definition
| Patients with structural heart disease but no HF signs or symptoms. Ex: Previous MI, LV hypertrophy, LV systolic dysfunction |
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Term
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Definition
| Patients with structural heart disease and current or previous symptoms. Ex: LV systolic dysfunction and symptoms such as dyspnea, fatigue, and reduced exercise tolerance |
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Term
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Definition
Refractory HF requiring specialized interventions.
Ex: Patients with treatment refractory sx at rest despite maximal medical tx (patients requiring recurrent hospitalization or who cannot be discharged without mechanical assist devices or inotropic therapy. |
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Term
| Approved beta blockers in US |
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Definition
Carvedilol:
I: 3.125 bid
Target: 85< 25 bid
85> 50 bid
Metoprolol Succinate
I:12.5-25mg d
T: 200mg d
do not double more than q 2 weeks |
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Term
| Goals of treatment for CHF |
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Definition
Improve patients QOL
Reduce symptoms
Prolong survival/slow disease progression
Reduce hospitalizations |
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Term
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Definition
ACE Inhibitors
Aldosterone Antagonist
Angiotension Receptor Blockers
Hydralazine/Nitrate Combos
Beta Blockers |
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Term
| Improve Symptoms without Improving Survival (3) |
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Definition
Loop Diuretics
Digoxin
Calcium Channel Blockers |
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Term
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Definition
| Normal or ST-T wave changes from myocardial ischemia, Afib, bradycardia, LV hypertrophy |
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Term
| HF findings on an Echocardiogram |
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Definition
| LV size, valve function, pericardial effusion, wall motion abnormalities, and EF |
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Term
| HF findings on physical exam |
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Definition
| pulmonary rales, pulmonary edema, S3 gallop, cool extremities, pleural effusion, cheyne-stokes respiration, tachcardia, narrow puse pressure, cardiomegaly, peripheral edema, JVD, hepato jugular reflux, hepatomegaly |
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Term
Drugs that may precipitate HF
(3 Types) |
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Definition
Negative Inotropes
Cardiotoxic
Na/H2O Retention |
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Term
Negative Inotropes
(8 drugs and 4 classes) |
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Definition
Antiarrhythmics (dipyramide, flecainide, propafenone)
B-Blockers(propranolol, metoprolol, and atenolol)
A-Blockers
NDHP CCB (verapamil, diltiazem)
Itraconazole
Terbinafine |
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Term
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Definition
| Doxorubicin, Daunomycin, Cyclophosphamide, Trastuzumab, Imatinib, EtOH, Amphetamines (DAD CITE) |
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Term
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Definition
NSAID
COX-2
Rosi-&Pioglitazone
Glucocorticoids
Androgens & Estrogens
Salicylates
Na containing drugs: cabenicillin disodium |
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Term
ACE-Inhibitors
Contraindications, Cautions, and Adverse Events |
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Definition
CI: HO angioedema and bilateral reanl-artery stenosis
Caut: K>5, SCr>2.5, symptomatic HOTN, or systolic BP<90
AE: cough, angioedema, rise in Cr or BUN, Hyperkalemia, and symptomatic HOTN |
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Term
Beta-Blockers
Contraindications, Cautions, and Adverse Events |
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Definition
CI: asthma and 2nd-or 3rd-degree atrioventricular block,
Caution: Recent decompensated heart failure and a HR<55bpm
AE: bradycardia and av vlock, bronchospasm, worsening HF during initiation of tx or increase in dosage, and symptomatic HOTN |
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Term
Angiotensin-receptor blockers
Contraidications, Cautions, and Adverse Events |
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Definition
CI: Bilateral renal-artery stenosis
Caution: K>5, Cr>2.5, symptomatic HOTN, Systolic BP<90
AE: rise in Cr or BUN, hyperkalemia, and symptomatic HOTN |
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Term
Aldosterone Blockers
Contraindications, Cautions, and Adverse Effects |
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Definition
CI: K>5
Caution: K>4.5 and SCr>2
AE: hyperkalemia, rise in Cr or BUN, and gynecomastia |
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Term
Hydralazine/Isosorbide dinitrate
Contraindications, Cautions, Adverse Effects |
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Definition
CI: Lupus
Caution: HOTN or Systolic BP<90
AE: HA, symptomatic HOTN, arthralgia, and lupus-like sydrome |
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Term
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Definition
| the ability of the heart to alter the force of contraction depends on changes in preload. As myocardial sarcomere length is stretched, the number of cross-bridges between thick and thin myofilaments increases, resulting in an increase in the force of contraction |
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Term
| Pathophysiology of Heart Failure |
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Definition
1. tachycardia and increased contractility through sympathetic nervous system (SNS) activation
2. the Frank-Starling mechanism, whereby an increase in preload results in an increase in stroke volume
3. vasoconstriction
4. vertricular hypertrophy and remodeling |
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