Questions and Answers
Acute decompensated heart failure (ADHF) is defined as new or worsening signs or symptoms of HF usually caused by ___________ that necessitates emergency department visits or hospitalizations.
Acute decompensated heart failure is also known as:
Which of the following is TRUE regarding the etiology of acute decompensated HF?
Hospitalize severely acute decompensated heart failure if: Select all that apply
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Precipitating factors for acute decompensated heart failure include: Select all that apply
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Which of the following are ways that medications can cause acute decompensated heart failure?
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Medications that precipitate acute decompensated heart failure (ADHF) tend to:
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Match the following drugs to their effects on precipitating ADHF.
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Factors that could compromise hemodynamic status causing acute decompensated HF include: Select all that apply
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Fluid accumulation is to 1_ as fluid redistribution is to____2___.
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Acute decompensated heart failure (ADHF) is defined as new or worsening signs or symptoms of HF usually caused by __________ that necessitates emergency department visits or hospitalizations.
Signup and view all the answers
Acute decompensated heart failure is also known as:
Signup and view all the answers
Which of the following is TRUE regarding the etiology of acute decompensated HF?
Signup and view all the answers
Hospitalize severely acute decompensated heart failure if: Select all that apply
Signup and view all the answers
Precipitating factors for acute decompensated heart failure include: Select all that apply
Signup and view all the answers
Which of the following are ways that medications can cause acute decompensated heart failure?
Signup and view all the answers
Medications that precipitate acute decompensated heart failure (ADHF) tend to:
Signup and view all the answers
Match the following drugs to their effects on precipitating ADHF.
Signup and view all the answers
Factors that could compromise hemodynamic status causing acute decompensated HF include: Select all that apply
Signup and view all the answers
Fluid accumulation is to 1_ as fluid redistribution is to____2___.
Signup and view all the answers
Acute decompensated heart failure (ADHF) is defined as new or worsening signs or symptoms of HF usually caused by ___________ that necessitates emergency department visits or hospitalizations.
Signup and view all the answers
Acute decompensated heart failure is also known as:
Signup and view all the answers
Which of the following is TRUE regarding the etiology of acute decompensated HF?
Signup and view all the answers
Hospitalize severely acute decompensated heart failure if: Select all that apply
Signup and view all the answers
Precipitating factors for acute decompensated heart failure include: Select all that apply
Signup and view all the answers
Which of the following are ways that medications can cause acute decompensated heart failure?
Signup and view all the answers
Medications that precipitate acute decompensated heart failure (ADHF) tend to:
Signup and view all the answers
Match the following drugs to their effects on precipitating ADHF.
Signup and view all the answers
Factors that could compromise hemodynamic status causing acute decompensated HF include: Select all that apply
Signup and view all the answers
Fluid accumulation is to 1_ as fluid redistribution is to____2___.
Signup and view all the answers
Study Notes
Acute Decompensated Heart Failure (ADHF)
- ADHF involves new or worsening heart failure symptoms, often due to volume overload, hypoperfusion, or both, leading to emergency visits or hospitalizations.
- Other names for ADHF include acute heart failure, acute heart failure syndrome, and cardiogenic pulmonary edema.
Etiology and Hospitalization
- Hospital admissions for ADHF have increased threefold in the past 30 years.
- 70% of cases arise from exacerbations of existing heart failure due to poor adherence, inadequate medication regimens, dietary indiscretions, or infections.
- 25% of cases are de novo, resulting from myocardial infarction (MI), arrhythmias, or sudden increases in blood pressure.
Precipitating Factors
- Precipitating factors include medications, dietary non-compliance, arrhythmias, uncontrolled hypertension, myocardial ischemia/infarction, anemia, endocrine abnormalities, infections, pulmonary emboli, and substance abuse.
Medication Effects
- Medications can worsen heart failure by promoting fluid retention, poor adherence, or recent initiation or dosage increases of beta-blockers.
- Certain drugs like NSAIDs, glitazones, and glucocorticoids promote fluid retention, while non-DHP CCBs and some other medications have negative inotropic effects or exhibit cardiotoxicity.
Clinical Presentation
- "Wet" ADHF indicates fluid overload with symptoms like peripheral edema, JVD, dyspnea, and increased creatinine/blood urea nitrogen (BUN).
- "Cold" ADHF presents with signs of poor perfusion such as cool extremities, hypotension, altered mental status, and worsening renal or hepatic function.
Hemodynamic Assessment
- Markers of hemodynamic stress include B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP), released in response to ventricular wall stress.
- ADHF can be confirmed by BNP >100 pg/mL or NT-proBNP >300 pg/mL. Increased levels can result from conditions like pulmonary emboli and renal dysfunction.
Laboratory and Monitoring Requirements
- Routine labs include BMP, liver function tests, oxygen saturation, and serum lactate.
- Careful monitoring encompasses volume status, oxygenation, weight, blood pressure, kidney function, and electrolytes during diuretic therapy.
Treatment Goals
- Goals for managing ADHF include symptom relief and lowering pulmonary capillary wedge pressure (PCWP) without compromising cardiac output.
- Loop diuretics are first-line therapy for volume overload; doses should be escalated accurately based on home regimen.
Diuretic Resistance and Strategies
- Diuretic resistance occurs due to compensatory sodium reabsorption. Management involves increasing doses, adding thiazide-type diuretics, or switching to continuous infusion.
IV Vasodilators
- IV vasodilators may be considered for managing refractory volume overload, acute pulmonary edema, and severe hypertension.
- Preferred IV vasodilators include nitroglycerin for preload reduction and sodium nitroprusside for balanced dual arterial and venous dilation, both requiring careful monitoring.
Non-Pharmacological Interventions
- Ultrafiltering fluid is effective for diuretic-resistant patients or those with renal impairment despite medical treatments.
Hyponatremia in HF
- ADHF is commonly associated with hypervolemic hyponatremia and treatment options include fluid restriction, diuretics, hypertonic saline, and vasopressin antagonists to correct sodium levels.
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Description
Test your knowledge on acute decompensated heart failure (ADHF) with this final quiz. It covers key definitions, causes, and related terms associated with ADHF. Perfect for nursing students or healthcare professionals preparing for exams.
