Acute Heart Failure

Question 1

What occurs in acute LVF?

Answer 1

Failure of systolic function of LV means its unable to eject blood around the body leading to back log in LA, pulmonary veins and lungs

-increased hypdrostatic pressure in lungs leads to fluid leaking= pulmonary oedema

Question 2

What is pulmonary oedema?

Answer 2

Lung tissue and alveolar become filled with interstitial fluid which inhibits normal gas exchange, leading to SOB and desaturation

Question 3

What are the possible causes of acute LVF?

Answer 3

Iatrogenic= elderly patients can become fluid overloaded if given aggressive IV fluids with already impaired LV function

Sepsis

Post-MI

Arrhythmias

Question 4

How might someone with acute LVF present and why? (S+S)

Answer 4

Rapid onset SOB, exacerbated by lying down= orthopnoea 
Type 1 resp failure picture= low O2 but no increase in CO2 
Cough w/ frothy/pink sputum 
Sweaty and pale 
Tachycardia 
Tachypnoea (Increased RR)
Raised JVP 
Bilateral basal fine crackles 
3rd heart sound 
Cardiac asthma (wheeze)

Question 5

Why might a raised JVP be present in these patients?

Answer 5

Might have right sided failure which leads to backlog of pressure into the right side of the heart and raises the pressure in the jugular veins of the neck

Question 6

What investigations might someone with acute LVF require? When should these investigations be done compared with treatment?

Answer 6

Need to treat acute LVF when clinical presentation enough to indicate as waiting to start treatment until results can lead to deterioration

BNP= indicator of pressure in ventricles i.e. released when myocardium stretched beyond normal range

Echo= measures LV function by measuring the ejection fraction

CXR

• cardiomegaly
• upper lobe venous diversion (increased prominence + diameter of upper lobe vessels on chest X-ray)
• bilateral pleural effusions
• interlobular fissures
• Kerley lines (fluid in septal lines)

ECG

Bloods= U+E/troponin/ABG

Question 7

How do you manage some one experiencing acute LVF?

Answer 7

Pour SOD

Pour away IV fluids

Sit patient upright to ensure upper lobes free of fluid for gas exchange

Oxygen if sats falling below 95%

Diuretics= 40mg IV furosemide stat
-decreases circ volume to decreased cardiac overload