Acute Heart Failure Flashcards
What type of situation is acute heart failure?
Life threatening emergency
What is acute heart failure?
Sudden onset or worsening of the symptoms of heart failure.
How can acute heart failure occur?
With or without a background of chronic heart failure
What is the term for acute heart failure presenting without a background of chronic heart failure?
De-novo acute heart failure
What is the term for acute heart failure presenting on a background of chronic heart failure?
Decompensated heart failure
What is acute heart failure due to?
Reduced cardiac output that results from a functional or structural abnormality.
What are the main precipotating factors for decompensated acute heart failure?
Acute coronary syndrome
Hypertensive crisis
Acute arrhythmia
Valvular disease
What investigations can be done for acute heart failure?
Blood tests
Chest X-ray
Echocardiogram
B-type natriuretic peptide
Why would you do a blood test in someone presenting with acute heart failure?
To look for
–Anaemia
–Abnormal electrolytes
–Infection
What would you look for on a chest x-ray of someone with acute heart failure?
Pulmonary venous congestion
Interstitial oedema
Cardiomegaly
Bilateral pulmonary oedema
When would you carry out an echocardiogram for someone presenting with acute heart failure?
New-onset heart failure
Known heart failure who have a suspected change in cardiac function
What level of BNP would be supportive of diagnosis of acute heart failure?
raised levels (>100mg/litre) indicate myocardial damage and are supportive of the diagnosis.
When would you suspect acute heart failure?
Breathless desaturating patient who has been gievn fluids
What is an example patient of acute heart failure?
85 year old patient with chronic kidney disease and aortic stenosis is prescribed 2 litres of fluid over 4 hours and then starts to drop her oxygen saturation
What type of blood gas does acute heart failure cause?
Type 1 respiratory failure (low oxygen without an increased carbon dioxide).
What is acute heart failure in simple terms?
Acute failure of the LV
What are the main symptoms of acute heart failure?
Shortness of breath- esp on exertion
Cough with frothy white or pink sputum
Orthopnoea
Bilateral basal crackles
Paroxysmal nocturnal dyspnoea
What signs might you find on examination of someone with acute heart failure?
Raised respiratory rate
Reduced oxygen saturations
Tachycardia
3rd heart sound
Bilateral basal crackles
Hypotension in severe case
When might a patient with acute heart failure become hypotensive?
Cardiogenic shock
What is the initial management of someone presenting with acute heart failure
IV loop diuretics
e.g. furosemide or bumetanide
What would you administer to patients with respiratory failurue in acute heart failure?
CPAP
What else can be given to a patient with acute heart failure?
oxygen
To keep saturations between 94-98%
When would you consider giving vasodilators to someone with acute heart failure?
Concomitant myocardial ischaemia
Severe hypertension
Regurgitant aortic or mitral valve disease
What is a major side effect of vasodilators?
hypotension
What are the main heart features that might suggest acute heart failure?
S3 heart sound
Displaced apex beat
tahcycardia
