Term
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Definition
new or worsened symptoms of heart failure (dyspnea, fatigue or edema) leading to unscheduled medical care or hospital admission |
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Term
ADHF triggered by volume overlaod |
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Definition
excess dietary sodium, hepatic dysfunction and kidney diseas |
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Term
ADHF triggered by increased metabolic demands |
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Definition
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Term
ADHF triggered by medications |
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Definition
non-adherence, cardiotoxic drugs |
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Term
ADHR related to substance abuse |
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Definition
stimulant drugs like cocaine and methamphetamine |
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Term
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Definition
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Term
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Definition
dyspnea, *orthopnea, fatigue, edema, *paroxysmal nocturnal dyspnea (PND), GI |
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Term
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Definition
orthopnea nd paroxysmal nocturnal dyspnea are signs of impending ADHF |
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Term
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Definition
pulmonary edema, decreased perfusion to organs (kidney, GI, Brain) |
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Term
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Definition
peripheral edema and hepatic congestion |
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Term
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Definition
CNS, pulmonary, Cardiovascular (jugular venous pressure), Renal and extremeties |
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Term
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Definition
ECG, chest radiography, and ECHO |
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Term
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Definition
left ventricular hypertrophy (MI), arrhythmias |
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Term
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Definition
alveolar edema, cardiomegaly |
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Term
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Definition
extent of ventricular dysfuction: ejection fraction, evaluate valves |
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Term
invasive studies with no mortality improvement and high risks |
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Definition
Pulmonary artery catheter (Swan-Ganz), cental venous catheter, coronary angiography |
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Term
Pulmonary artery catheter |
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Definition
determines hemodynamic parameters (PCWP, CVP, SvO2, CI) |
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Term
Pulmonary artery catheter indications |
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Definition
ADHF with persistent symptoms despite standard therapies (diuretics etc), uncertain hemodynamics |
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Term
Central venous pressure (CVP) |
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Definition
measures RA pressure (RV preload) |
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Term
pulmonary capillary wedge pressure (PCWP) |
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Definition
reflects left sided filling pressure (LV preload) |
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Term
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Definition
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Term
systemic vascular resistance (SVR) |
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Definition
resistance of peripheral circulation (afterload) |
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Term
Mean arterial pressure (MAP) |
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Definition
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Term
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Definition
central venous oxygen saturation |
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Term
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Definition
mixed oxygen saturation, oxy sat in the pulmonary artery |
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Term
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Definition
86% pos predictive value for ADHF |
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Term
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Definition
96% neg predictive value for ADHF |
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Term
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Definition
sudden onset, very serious, intubation is often required |
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Term
acute kidney injury (AKI) |
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Definition
common after prolonged episodes of hypoperfusion |
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Term
hypotension leading to cardiogenic shock |
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Definition
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Term
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Definition
warm and dry (normal); minimal perfusion issues and congestion |
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Term
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Definition
warm and wet; more congestion but minimal perfusion issues |
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Term
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Definition
cold and dry; more perfusion but minimal congestion issues |
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Term
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Definition
cold and wet; serious issues with perfusion AND congestion |
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Term
initial monitory and management |
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Definition
stabilization: O2 supplement, vitals, continuous cardiac rhythm and urine output |
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Term
initial correction of volume overload and hemodynamic abnormalities |
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Definition
in this order: diuretics, vasodilators, inotropes and vasopressors |
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Term
oxygenation is VERY important because |
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Definition
both cardiac output AND oxygen saturation is depleted in ADHF |
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Term
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Definition
should be continued during hospitalization |
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Term
sometimes home meds need to be stopped (low BP leading to shock) |
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Definition
BUT reinitiation ASAP improves outcomes |
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Term
discontinue home meds in the setting of |
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Definition
hypoTN, cardiogenic shock, AKI, or hyperkalemia |
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Term
if patient doesn't present with fluid overload |
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Definition
still consider diuretic because most likely they have some pulmonary congestion |
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Term
loop diuretic pharmacology |
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Definition
reduce right and left filling pressures (preload) to improve forward flow |
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Term
caution with loop diuretics |
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Definition
in hemodynaic instability and aortic stenosis |
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Term
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Definition
start patient on IV dose same as home dose to achieve double the diuretic dose with increased bioavailability |
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Term
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Definition
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Term
doses higher than 100 mg of furosemide |
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Definition
should be administered over 1 hour to prevent ototoxicity |
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Term
know daily weights, particularly the weight of the patient before ADHF episode |
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Definition
shoot for this weight goal with loop diuretic therapy |
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Term
strategies for diuretic resistance |
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Definition
increase dose or switch drug, use IV formulation continuous infusion, additional thiazide, addition of aldosterone antagonist |
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Term
vasopressin antagonist agents |
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Definition
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Term
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Definition
elevated in patients with HF |
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Term
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Definition
antagonizes V1a (smooth muscle vasoconstriction) and V2 (fluid retention) |
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Term
advantage of vasopressin antagonists |
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Definition
does not activate neurohormonal system |
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Term
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Definition
IV, failed to show improvement and not considered routine treatment |
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Term
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Definition
oral, no improvement and leads to rapid increase in Na levels |
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Term
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Definition
nitroglycerine and nitroprusside |
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Term
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Definition
rapid symptom relief in patients with acute pulmonary edema or severe hyPERtension that do not respond to diuretics alone |
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Term
vasodilator IV continuous use |
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Definition
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Term
venodilation with nitroglycerine |
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Definition
reduces left ventricular filling pressure (PRELOAD) |
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Term
dilation of coronary arteries with nitroglycerine |
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Definition
improves collateral flow to ischemic regions |
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Term
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Definition
preload and afterload reduction |
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Term
nitroprusside converted to |
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Definition
cyanide (hepatic failure-metabolic acidosis) by the liver and excreted as thiocyanate (renal failure-AMS, seizures) in urine |
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Term
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Definition
increases cyclic GMP causing smooth muscle relaxation, results in naturesis, very expensive! |
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Term
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Definition
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Term
increased contractility, some vasodilation |
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Definition
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Term
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Definition
severe LV systolic dysfuction with inadequate response to diuretic therapy, improve end organ function in patients with advanced HF until definitive therapy determines |
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Term
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Definition
phosphodiesterase inhibitor resulting in decreased cAMP, can use in combo with nitro and BB |
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Term
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Definition
B1 adrenergic receptor agonist, minor B2 receptor agonist improved CO, minor reduction in SVR and PCWP; must STOP BB |
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Term
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Definition
norepinephrine, dopamine, epinephrine, isoproterenol |
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Term
pharmacology of vasopressors |
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Definition
increased strength (inotropy) and frequency (chronotropy) of contraction resulting in increased CO |
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Term
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Definition
avoid peripheral extravasation, use central venous cath |
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Term
warm and dry (category I) |
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Definition
continue maintenance therapy, prevent progression |
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Term
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Definition
diuretics (+/- vasodilators) |
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Term
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Definition
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Term
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Definition
diuretics, inotropes, vasopressors |
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