"acute on chronic" HF is - Answer-an acute exacerbation of a chronic condition
/.↑ afterload = - Answer-↑ cardiac workload
/.↓ CO leads to - Answer-↓ blood and O2 to organs
/.↓ SV leads to - Answer-↓ CO
/.2 classification systems of heart failure - Answer-functional classification: New York
Heart Association (NYHA)
stages of HF: American College of Cardiology Foundation/American Heart Association
(ACCF/AHA)
need both classifications!
/.3 main goals of HF treatment - Answer-1) treat the underlying cause and contributing
factors⟶ ↓ preload, ↓ afterload, ↑ contractility
2) alleviate symptoms⟶ ↑ QOL, monitor for depression
3) preserve organ function⟶ ↓ mortality and morbidity
/.4 core measures of heart failure - Answer-Discharge instructions⟶ weight, activity,
medications, follow up and when to call dr.
LV function is documented (EF)
If EF <40% must be on ACE or ARB
Smoking Cessation
/.A patient comes is admitted to the hospital complaining of shortness of breath. His EF
is 60%. Which type of HF is the patient experiencing? - Answer-Diastolic
/.ACE inhibitor side effects - Answer-ACE
A-angioedema (swelling of face, arms, legs, abdomen)
C-cough
E-elevated K+
renal insufficiency d/t messing w/ RAAS system
/.ACE inhibitors - Answer-blocks enzyme that converts angiotensin I to II
LVHF: ↑ pulmonary venous pressure⟶ engorgement of pulmonary vascular system
Now lungs less compliant, ↑ resistance in small airways
↑↑ pulmonary venous pressure⟶ interstitial edema: alveoli cells disrupted and fluid
w/RBC moves into the alveoli⟶ PULMONARY EDEMA
/.ADHF is controlled with - Answer-same as mild plus:
nitroglycerin
hemodynamic monitoring
/.Aldosterone antagonists MOA - Answer-Bind to receptors at the aldosterone-
dependent Na-K exchange sites in distal renal tube
Block aldosterone⟶ potassium-sparing diuretics
Promotes Na and water excretion—K retaining
, /.all together, the neurohormonal response in HF leads to - Answer-↑ cardiac workload
myocardial dysfunction
ventricular remodeling (abnormal contractile cells)
overall, tells heart to grow more muscle to work harder⟶ this is the wrong direction
/.Allen test for arterial line - Answer-assesses ulnar flow
radial and ulnar arteries simultaneously occluded while the patient makes fist⟶ hand is
opened, appears blanched⟶ release of ulnar artery should result in return of hand color
in 8-10 seconds
/.American College of Cardiology Foundation/ American Heart Association
(ACCF/AHA): Stage A - Answer-@ high risk for HF but w/o structural heart disease or
symptoms
/.American College of Cardiology Foundation/ American Heart Association
(ACCF/AHA): Stage A drugs - Answer-ACEs, ARBs, statins as appropriate
/.American College of Cardiology Foundation/ American Heart Association
(ACCF/AHA): Stage A goals - Answer-heart healthy lifestyle, prevent vascular and
coronary disease, prevent LV structural abnormalities
/.American College of Cardiology Foundation/ American Heart Association
(ACCF/AHA): Stage A likely pts with - Answer-HTN, atherosclerotic disease, DM,
obesity, metabolic syndrome, using cardiotoxins, w/ family hx of cardiomyopathy
/.American College of Cardiology Foundation/ American Heart Association
(ACCF/AHA): Stage B - Answer-@ risk for HF⟶ structural heart disease but w/o
symptoms
/.American College of Cardiology Foundation/ American Heart Association
(ACCF/AHA): Stage B goals - Answer-prevent HF symptoms, prevent further cardiac
remodeling
/.American College of Cardiology Foundation/ American Heart Association
(ACCF/AHA): Stage B likely pts with - Answer-previous MI, LV remodeling incl LVH and
low EF, asymptomatic valvular disease
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