> For the complete documentation index, see [llms.txt](https://thisispiggy.gitbook.io/my-wiki/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://thisispiggy.gitbook.io/my-wiki/01-step-1/cardiology/27-acute-hf.md). # 27 Acute HF [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/acute%20vs%20chronic%20HF/README.md).. ![](https://f001.backblazeb2.com/file/wikiFiles/JyxaRB8.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/3nTd5VH.jpg) * treatment very different for acute and chronic * acute: symptoms of fluid overload, need hospital therapy * chronic: after treatment at hospital, feels much better, still sick and at risk of dying ## Causes [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/acute%20HF%20causes,%20pathogenesis/README.md).. ![](https://f001.backblazeb2.com/file/wikiFiles/bz14Ztn.jpg) * fast food, high salt * acute exacerbation from lack of med compliance ![](https://f001.backblazeb2.com/file/wikiFiles/uD0xEue.jpg) * nl: transient rise in volume triggers RAAS overtime to relieve volume * HF: transient rise very dangerous, symptoms of HF, hospital ![](https://f001.backblazeb2.com/file/wikiFiles/1QEE7wZ.jpg) * NSAIDS high yield: taking high dose NSAIDS to treat arthritis classic cause of HF ![](https://f001.backblazeb2.com/file/wikiFiles/t7MSOYP.jpg) * Constricted proximal end of hose: NSAIDs cause afferent arteriole vasoconstriction, decreasing GFR * Bursting from high pressure: NSAIDs can increase blood pressure due to COX inhibition in the kidney, decreasing sodium excretion ![](https://f001.backblazeb2.com/file/wikiFiles/2bBuWTv.jpg) * Tall man dousing failing heart balloon: mannitol induced expanded extracellular volume can exacerbate heart failure ![](https://f001.backblazeb2.com/file/wikiFiles/LGVL6Nf.jpg) * Failing heart balloon locked out of store: CCBs can worsen heart failure (increased sympathetic activity and decreased contractility) ![](https://f001.backblazeb2.com/file/wikiFiles/C2KRST6.jpg) * Darts deflating failing heart balloon: disopyramide can exacerbate heart failure (negative inotropy) ![](https://f001.backblazeb2.com/file/wikiFiles/gRuqWDx.jpg) * Trampled failing heart balloon: amiodarone can induce heart failure ## Treatment [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/acute%20HF%20treatment%20goal%20and%20drugs/README.md).. ![](https://f001.backblazeb2.com/file/wikiFiles/AHeMBaO.jpg) * chronic: they already feel better, thus improve mortality more important 3 ways: * reduce volume (diuretics) * vasodilate: reduce afterload/preload (vasodilators) * increase contractility (ionotropes) ### Diuretics ![](https://f001.backblazeb2.com/file/wikiFiles/lZIYAN0.jpg) * main treatment for both systolic and diastolic ![](https://f001.backblazeb2.com/file/wikiFiles/QxK39GX.jpg) * in acute: gut is often swollen, give IV ![](https://f001.backblazeb2.com/file/wikiFiles/ZnQFgok.jpg) * Furious kid: furosemide (a loop diuretic) * Ethics: ethacrynic acid (a loop diuretic) * Sulfa-less ethics: ethacrynic acid is not a sulfa drug * Failing heart balloon: loop diuretics are 1st line for the symptomatic treatment of acute decompensated heart failure with fluid overload * Wet lungs: loop diuretics treat symptoms of pulmonary edema in an acute heart failure exacerbation * Yellow inner tube: loop diuretics treat ascites in liver failure ![](https://f001.backblazeb2.com/file/wikiFiles/lbkQSlB.jpg) * given together with loop: more Na to DCT from loop. Inhibit more Na absorption at DCT = more excretion ![](https://f001.backblazeb2.com/file/wikiFiles/QqQxFuX.jpg) * Failing heart balloon: thiazide diuretics can be useful in the symptomatic treatment of heart failure (loop diuretics are first line) ### Vasodilators ![](https://f001.backblazeb2.com/file/wikiFiles/q2gef2c.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/jHfVolP.jpg) * Wet lung spots: nitroglycerine is an acute treatment for pulmonary edema ![](https://f001.backblazeb2.com/file/wikiFiles/7sqzvw1.jpg) * acute HF with very high BP, give vasodilators to help ![](https://f001.backblazeb2.com/file/wikiFiles/JbCySDz.jpg) * Failing heart balloon: ACE inhibitors are first line agents in the treatment of chronic heart failure (reduce peripheral resistance, afterload, and blood volume, preload; less Ang II, less sympathetic activity on heart ) ![](https://f001.backblazeb2.com/file/wikiFiles/Y8SYiHx.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/xOP7noE.jpg) * Hydro-boat: hydralazine treats hypertensive emergency * Dilated red hose: hydralazine is a direct arteriolar vasodilator * Dynamite: nitrate (e.g. nitroglycerine) * Failing heart balloon: hydralazine combined with a nitrate (e.g. nitroglycerine) treats heart failure (hydralazine arteriodilation, nitrate venodilation) ### Inotropes ![](https://f001.backblazeb2.com/file/wikiFiles/IH6kGkj.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/37ppo5o.jpg) * reserved for ICU pts ![](https://f001.backblazeb2.com/file/wikiFiles/a053f19.jpg) * One in a million: milrinone * Don't phoster disinterest: milrinone inhibits phosphodiesterase * CAMPaign: milrinone decreases breakdown of cAMP * Flexing arm: milrinone increases cardiac contractility * Dilated red donkey ears: milrinone causes arteriolar dilation and decreased afterload. Hypotension SE ![](https://f001.backblazeb2.com/file/wikiFiles/bEHHxpB.jpg) * milrinone and dobutamine main ones ![](https://f001.backblazeb2.com/file/wikiFiles/L4Nxc04.jpg) * "Just DO BUgling" winding up heart flashlight: dobutamine increases heart rate, contractility, and cardiac output (beta-1 effects) * "Just DO BUgling" friend's dilated sleeves: dobutamine causes vasodilation -> decreases SVR (effects mild due to minimal beta-2 activity) * Dobutamine increases PULSE PRESSURE, difference between systolic and diastolic (beta-1 increase in contractility) * Dobutamine increases systolic pressure (beta-1 increase in CO) * Dobutamine can decrease diastolic pressure (beta-2 arteriolar dilation) * Others: ![](https://f001.backblazeb2.com/file/wikiFiles/uZMboBW.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/E9V42zW.jpg) * Low kidney tied to single rope: low doses of dopamine act on D1 receptors to increases renal blood flow * Beta bugler in the middle: medium doses of dopamine activate beta-1 receptors (cardiac activation) * Alpha scout up high: high doses of dopamine activate alpha-1 receptors (pressor effects) * Brain helmet on double rope swing: D2 receptors are found in the CNS ![](https://f001.backblazeb2.com/file/wikiFiles/75HzrLM.jpg) [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/inotrope%20risks%20in%20HF/README.md).. ![](https://f001.backblazeb2.com/file/wikiFiles/LlDzVPK.jpg) * given usually in hospitals under supervision because dangerous * stimulate heart in pts with sick heart vulnerable to arrythmias [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/ignore/README.md).. ![](https://f001.backblazeb2.com/file/wikiFiles/IT1mqZu.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/TEdP61N.jpg) * Cr rising: under perfusion of kidneys ![](https://f001.backblazeb2.com/file/wikiFiles/ZxBmBBS.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/VdZBKHx.jpg) * quality of care ![](https://f001.backblazeb2.com/file/wikiFiles/vw2HKyA.jpg) * nitrate to feel better ![](https://f001.backblazeb2.com/file/wikiFiles/g9A5wZb.jpg) [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/digoxin%20and%20acute%20HF/README.md).. ![](https://f001.backblazeb2.com/file/wikiFiles/47Z40Lz.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/bPDH3lQ.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/fkaUtyZ.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/jyEOEYh.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/a053f19.jpg) * Deflated heart balloon: symptomatic treatment of chronic systolic heart failure