Term
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Definition
| rapid onset or change in HF symptoms and signs, requiring urgent treatment |
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Term
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Definition
| rapid onset, usually secondary to other acute cardiac causes |
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Term
| acute decompensated heart failure (ADHF) |
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Definition
| worsening symptoms in patients with preexisting HF |
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Term
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Definition
| evidence of tissue hypoperfusion induced by HF after correction of preload |
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Term
BNP - better correlated with left ventricular end diastolic pressure
NT-proBNP - a byproduct of BNP synthesis and is secreted in proportion to BNP |
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Definition
synthesized in response to ventricular stretch
cause vasodilation -> counteracts vasoconstriction
induce Na excretion -> counteracts Na/water retention |
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Term
cardiac causes: myocaridal ischemia or infarction, arrhythmias, pulmonary embolism, vavlular disease, uncontrolled HTN
infection
anemia
thyroid disease (hyperthyroidism)
**non-adherence: medications, dietary restrictions**
medication induced: non DHP CCB are contraindicated in AHF |
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Definition
| precipitating factors of AHF |
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Term
Na/water retention: **NSAIDS**, thiazolidinediones, steroids, drugs with high Na content
negative inotropes: antiarrhythmics, B blockers, **non DHP CCB**, alcohol, cocaine |
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Definition
| medications that can cause AHF |
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Term
symptoms: dsypnea/DOE, orthopnea/PND, cough, peripheral edema, abdominal swelling, abdominal pain/nausea/bloating, weight gain
signs: rales/crackles, hypoxemia, JVD, HJR, pleural effusion/pulmonary congestion on CXR, hepatomegaly/ascites |
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Definition
| clinical presentation of volume overload |
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Term
symptoms: sleepiness, confusion, cold and clammy skin, cold extremities, decreased urine output
signs: cyanosis, poor capillary refill, weak extremity pulses, hypotension (SBP<90), tachycardia (HR>90), acidosis, increased BUN/SrCr (decreased kidney perfusion), increased LFT |
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Definition
| clinical presentation of hypoperfusion |
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Term
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Definition
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Term
| uncertain diagnosis (LV dysfunction, pulmonary embolism, renal dysfunction) |
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Definition
BNP 100-400
NT proBNP 400-2000 |
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Term
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Definition
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Term
arterial line: continuous arterial BP monitoring, frequent ABG draws
central venous catheter: delivers fluid and drugs into central circulation, measures central venous pressure (CVP), measures venous oxygen saturation
pulmonary artery catheter (Swan-Ganz): measures and calculates hemodynamic parameters, such as left ventricular pressure, fallen out of favor due to high complication rates |
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Definition
invasive monitoring:
arterial line
central venous catheter
pulmonary artery catheter (Swan-Ganz) |
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Term
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Definition
| pulmonary capillary wedge pressure (PCWP) estimates ( ) |
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Term
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Definition
| cardiac index is CO divided by BSA. it is standardized so comparisons can be made. Tells you if a patient is ( ) |
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Term
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Definition
| systemic vascular resistance estimates ( ) |
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Term
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Definition
| mean arterial pressure (MAP) evaluates ( ) |
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Term
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Definition
| at what point does a PCWP reading indicate AHF? |
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Term
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Definition
| at what point does a cardiac index reading indicate HF? |
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Term
refractory HF symptoms
refractory hypotension (SBP < 80)
worsening renal function during therapy
concurrent cardiac and pulmonary disease
hypoxia in need of intubation |
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Definition
| patients with these conditions will be considered for invasive monitoring |
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Term
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Definition
therapy used if the patient is fluid overloaded
[image]
first line treatment of symptoms due to mild to moderate fluid retention
if once daily dosing at home, double the dose and give as IV bolus OR
if on multiple doses at home, total daily dose given as IV bolus
if no adequate diuresis, double the subsequent doses until achieved
try to maintain a net loss of 1L |
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Term
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Definition
lack of or inadequate increase in urine output despite increasing diuretic dose
decreased intravascular volume -> increased RAAS and SNS
decreased renal perfusion due to low CO
Na overload |
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Term
Na and water restriction (2g of Na and 2L of water)
increase diuretic dosing frequency or give as continuous infusion
combine with another diuretic
may consider cautious fluid replacement if intravascularly dry
may consider adding inotrope if hypoperfusion is suspected |
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Definition
| how to overcome diuretic resistance |
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Term
vasodilators
venous vasodilators: nitroglycerin, nitroprusside, nesiritide
arterial vasodilators: nitroprusside, nesiritide |
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Definition
| should be considered in patients with persistent symptoms despite aggressive loop diuretics and have SBP > 110-120 mmHg (avoid in SBP < 90) |
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Term
nitroglycerin: tolerance
nitroprusside: cyanide or thiocyanate accumulation
nesiritide: increased risk of worsening renal function, increased risk of death |
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Definition
| adverse effects of vasodilators |
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Term
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Definition
therapy used if the patient is intravascularly dry
[image]
however, further increase in preload in a failing heart may exacerbate the condition
if unsure of preload and the patient has signs of hypoperfusion (cardiogenic shock) this may be attempted
if no improvement in BP, inotrope should be considered |
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Term
dobutamine
dopamine
milrinone |
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Definition
( ) is the inotrope of choice. concurrent use of BB should be DC'd
( ) is indicated in SBP <90 or symptothetic hypotension, despite dobutamine
( ) is indicated for low CO, but SBP is > 90 and on concurrent BB. |
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Term
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Definition
therapy reserved for sicker patients
signs of hypoperfusion despite vasodilators and/or diuretics
unresponsive/intolerant to vasodilator (add to or replace vasodilators)
severe LV systolic dysfunction (low EF)
cardiogenic shock
may allow continued diuretic +/- vasodilator therapy
lowest possible dose for the shortest possible duration
continuous monitoring of BP and EKG
used most in subset 4 patients (wet and cold) |
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Term
vasopressors
adrenergic agonists
EPI and NE |
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Definition
only use in cardiogenic shock with severe hypotension (SBP < 70)
may exacerbate high SVR and further decrease organ perfusion |
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Term
| for fluid overload patient with inadequate response to diuretic therapy |
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Definition
ultrafiltration filters the blood in order to remove excess Na and water.
It pulls off more fluid than IV diuretics without effecting BP, HR, or electrolytes.
when is it used? |
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