NSG 555 Quiz 2 UPDATED ACTUAL Questions and CORRECT
Answers
HF definition clinical syndrome defined by: any structural or functional impairment of
ventricular filling or ejection of blood
Stages of heart failure stage A- cardiac structure abnormalities but no symptoms. goal: reduce risk
stage B-increased filling pressures, persistently elevated troponin without dx or
increased BNP
stage C-Structural heart disease with current or previous symptoms of HF.
stage D- Marked HF symptoms that interfere with daily life and with recurrent
hospitalizations despite attempts to optimize GDMT.
most common causes of HF ischemic heart disease and myocardial infarction (MI), hypertension, and valvular
heart disease (VHD
approach to HF clinicians should seek the cause of HF because appropriate treatment may be
determined by the cause
assessing clinical s/s of congestion in HF presence of jugular venous distention, orthopnea, bendopnea, a square-wave
response to the Valsalva maneuver, and leg edema
lab studies for heart failure complete blood count, urinalysis, serum electrolytes (including sodium,
potassium, calcium, and magnesium), blood urea nitrogen, serum creatinine,
glucose, fasting lipid profile, liver function tests, iron studies (serum iron, ferritin,
transferrin saturation), and thyroid-stimulating hormone level and
electrocardiography
imaging recommendations for HF comprehensive TTE is the most useful initial diagnostic test given the vast amount
of diagnostic and prognostic information provided. The determination of LVEF is a
fundamental step to classify HF and to guide evidence-based pharmacological
and device-based therapy
exercise tolerance testing in HF CPET and the 6-minute walk test are standardized, reliable, and reproducible tests
to quantify functional capacity.19-22 The NYHA functional classification can be
used to grade the severity of functional limitation based on patient report of
symptoms experienced with activity1 and is used to define candidates for certain
treatments.
Stage A heart failure management patients who are at high risk for developing heart failure but have no structural
abnormalities
BP <130/80
diet
exercise
weight loss
stop smoking
If diabetics SGLT2 (flozin) or GLP-1 (tide)
, Stage B heart failure management pre-HF (increased filling pressures, persistently elevated troponin without dx or
increased BNP)
Start ACEI or ARB if LVEF <40
BB if LVEF <40 and hx CAD or MI (some also say just start these anyway)
ICD if LVEF <30
Statin if indicated
NO CCBs OR TZDs !!!!
Stage C and D management ACE/ARB
SGLT2 if dbtc or GLP-1
BB
Diuretic if needed (spironolactone)
diuretics in HF Bumetanide, furosemide, and torsemide inhibit reabsorption of sodium or chloride
at the loop of Henle, whereas thiazide and thiazide-like diuretics act in the distal
convoluting tubule and potassium-sparing diuretics (eg, spironolactone) in the
collecting duct.
Loop diuretics are the preferred diuretic agents for use in most patients with HF.
Thiazide diuretics such as chlorthalidone or hydrochlorothiazide may be
considered in patients with hypertension and HF and mild fluid retention.
Metolazone or chlorothiazide may be added to loop diuretics in patients with
refractory edema unresponsive to loop diuretics alone.
spironolactone in HF MRA (also known as aldosterone antagonists or anti-mineralocorticoids) show
consistent improvements in all-cause mortality, HF hospitalizations, and SCD
across a wide range of patients with HFrEF.1-3 Patients at risk for renal dysfunction
or hyperkalemia require close monitoring, and eGFR ≤30 mL/min/1.73 m2 or
serum potassium ≥5.0 mEq/L are contraindications to MRA initiation
African american specific stage C or D recommendations + hydralazine+isosorbide
infective endocarditis pathogens staph aureus, strep pyogenes, s. pneumonia, n. gonorrhea . S. aureus Is most
common
valves most commonly affected in endocarditis mitral valve and aortic valve. Often due to prior damage
presentation infective endocarditis fever, chills, poor appetite, wt loss, murmurs!, embolic complications (neurological
findings--szr, meningitis, arteritis, etc)
Roth spots (retinal spots taht are swollen, red and exudative)
petichiae and splenomegaly may be present, janeway/osler nodes
muscle pain, joint pain
Answers
HF definition clinical syndrome defined by: any structural or functional impairment of
ventricular filling or ejection of blood
Stages of heart failure stage A- cardiac structure abnormalities but no symptoms. goal: reduce risk
stage B-increased filling pressures, persistently elevated troponin without dx or
increased BNP
stage C-Structural heart disease with current or previous symptoms of HF.
stage D- Marked HF symptoms that interfere with daily life and with recurrent
hospitalizations despite attempts to optimize GDMT.
most common causes of HF ischemic heart disease and myocardial infarction (MI), hypertension, and valvular
heart disease (VHD
approach to HF clinicians should seek the cause of HF because appropriate treatment may be
determined by the cause
assessing clinical s/s of congestion in HF presence of jugular venous distention, orthopnea, bendopnea, a square-wave
response to the Valsalva maneuver, and leg edema
lab studies for heart failure complete blood count, urinalysis, serum electrolytes (including sodium,
potassium, calcium, and magnesium), blood urea nitrogen, serum creatinine,
glucose, fasting lipid profile, liver function tests, iron studies (serum iron, ferritin,
transferrin saturation), and thyroid-stimulating hormone level and
electrocardiography
imaging recommendations for HF comprehensive TTE is the most useful initial diagnostic test given the vast amount
of diagnostic and prognostic information provided. The determination of LVEF is a
fundamental step to classify HF and to guide evidence-based pharmacological
and device-based therapy
exercise tolerance testing in HF CPET and the 6-minute walk test are standardized, reliable, and reproducible tests
to quantify functional capacity.19-22 The NYHA functional classification can be
used to grade the severity of functional limitation based on patient report of
symptoms experienced with activity1 and is used to define candidates for certain
treatments.
Stage A heart failure management patients who are at high risk for developing heart failure but have no structural
abnormalities
BP <130/80
diet
exercise
weight loss
stop smoking
If diabetics SGLT2 (flozin) or GLP-1 (tide)
, Stage B heart failure management pre-HF (increased filling pressures, persistently elevated troponin without dx or
increased BNP)
Start ACEI or ARB if LVEF <40
BB if LVEF <40 and hx CAD or MI (some also say just start these anyway)
ICD if LVEF <30
Statin if indicated
NO CCBs OR TZDs !!!!
Stage C and D management ACE/ARB
SGLT2 if dbtc or GLP-1
BB
Diuretic if needed (spironolactone)
diuretics in HF Bumetanide, furosemide, and torsemide inhibit reabsorption of sodium or chloride
at the loop of Henle, whereas thiazide and thiazide-like diuretics act in the distal
convoluting tubule and potassium-sparing diuretics (eg, spironolactone) in the
collecting duct.
Loop diuretics are the preferred diuretic agents for use in most patients with HF.
Thiazide diuretics such as chlorthalidone or hydrochlorothiazide may be
considered in patients with hypertension and HF and mild fluid retention.
Metolazone or chlorothiazide may be added to loop diuretics in patients with
refractory edema unresponsive to loop diuretics alone.
spironolactone in HF MRA (also known as aldosterone antagonists or anti-mineralocorticoids) show
consistent improvements in all-cause mortality, HF hospitalizations, and SCD
across a wide range of patients with HFrEF.1-3 Patients at risk for renal dysfunction
or hyperkalemia require close monitoring, and eGFR ≤30 mL/min/1.73 m2 or
serum potassium ≥5.0 mEq/L are contraindications to MRA initiation
African american specific stage C or D recommendations + hydralazine+isosorbide
infective endocarditis pathogens staph aureus, strep pyogenes, s. pneumonia, n. gonorrhea . S. aureus Is most
common
valves most commonly affected in endocarditis mitral valve and aortic valve. Often due to prior damage
presentation infective endocarditis fever, chills, poor appetite, wt loss, murmurs!, embolic complications (neurological
findings--szr, meningitis, arteritis, etc)
Roth spots (retinal spots taht are swollen, red and exudative)
petichiae and splenomegaly may be present, janeway/osler nodes
muscle pain, joint pain
