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
|
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
|
Definition
| diuretics, inotropes, vasopressors |
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