Pathophysiology/Etiology
These are some common risk factors for heart failure. (List 2)
What are HTN, diabetes, atherosclerotic disease, dilated cardiomyopathies?
A common physical finding in patients with volume overload. (name 2)
What are peripheral edema, JVD, pulmonary edema?
This is the ejection fraction at which a patient is considered to have HFrEF
What is less than or equal to 40%?
Diuretics are often adjusted based on daily measurements of these two factors.
What are weights and I/O's?
Name one cause of an acute worsening of symptoms of heart failure.
What is non-adherence to medications, nonadherence to sodium restriction, acute coronary syndrome, uncorrected high blood pressure, atrial fibrillation, infections, drugs, etc.?
These two components make up cardiac output.
What are heart rate and stroke volume?
Medical term for when patients get more short of breath doing activities of daily living.
What is dyspnea upon exertion?
These are the two classification systems for heart failure.
What are ACCF/AHA Stages and NYHA Classification?
The AHA recommends that patients with HF limit their sodium to this amount daily.
What is 1500 mg?
This class of medication and route of administration should be used for patients who are considered to be wet.
What are IV loop diuretics?
This type of dysfunction is caused by destruction or abnormal function of myocytes or fibrosis and increased resistance to flow.
Systolic dysfunction
Patients will often report this symptom while trying to sleep.
What is paroxysmal nocturnal dyspnea?
These are ways to overcome diuretic resistance. (Be able to name at least 1)
What is increasing the dosing or the frequency, administering IV diuretics, or adding an additional diuretic (thiazide or thiazide-like diuretic)?
These three beta blockers have been proven to reduce mortality in patients with HFrEF.
What are bisoprolol, carvedilol, and sustained release metoprolol succinate?
A wet patient will have any of these symptoms. (name 2), and a cold patient will have any of these symptoms. (name 2)
What is edema, orthopnea, elevated jugular venous pressure, or pulmonary rales for a wet patient? What is narrow pulse pressure, cool extremities, end organ damage (elevated LFTs or SCr), or hypotension for a cold patient?
The pressure that the heart works against to eject blood.
What is afterload?
This is a biomarker that is often elevated in heart failure.
What is BNP?
These medications can reduce risk of death in patients with HFrEF. (must name all)
What is an ACE-I/ARB/ARNI, Beta-Blocker, Aldosterone antagonists, and Hydralazine/Isosorbide dinitrate?
Hydralazine/nitrate combination reduce morbidity and mortality in this population of patients, but can have poor adherence due to these factors. (name population used in and 2 factors contributing to poor adherence)
What is use in African Americans and large number of tablets, frequency of administration, adverse effects (headache, GI complaints, dizziness)?
What are two common inotropic medications that can be used for patients with low perfusion at rest (cold)?
What are dobutamine and milrinone?
Compensatory mechanism that helps to maintain a near normal perfusion to vital organs and maximizes stroke volume, but can cause pulmonary and systemic congestion as well as cardiac remodeling.
What is activation of renin-angiotensin-aldosterone system?
The lung sound heard during ascultation of lung bases. It results from backup of blood, which increases blood pressure and causes fluid to collect in the air sacs
What are crackles?
Ivabridine can be beneficial to reduce HF hospitalizations for patients with symptomatic (NYHA class II-III) stable chronic HFrEF at this ejection fraction who are in a sinus rhythm at this heart rate or greater.
What is less than or equal to 35% and who are in a sinus rhythm with a heart rate of 70 bpm or greater at rest?
There should be this many hours of washout between starting Entresto and discontinuing an ACEI.
What is 36 hours?
These types of medications can be used for patients who have dyspnea and intact blood pressure.
What are vasodilators (nitroprusside and nitroglycerin)?