Acute Heart Failure Flashcards
What is Acute Heart Failure (AHF)?
AHF is a life-threatening condition where the heart fails to pump enough blood to meet the body’s needs, leading to the rapid onset or worsening of heart failure symptoms.
What are the two main pathological developments in AHF?
Congestion in pulmonary or systemic circulation (leading to pulmonary edema and hypoxia).
Hypoperfusion of vital organs due to reduced cardiac output.
What are some common causes of new-onset AHF?
Common causes include acute myocardial dysfunction (e.g., myocardial infarction), acute valve dysfunction, and arrhythmias.
What are common causes of acute decompensation in chronic heart failure (CHF)?
Causes include infections, acute myocardial dysfunction, uncontrolled hypertension, arrhythmias, worsening chronic valve disease, non-adherence to medications or diet, and changes in drug regimens.
What are the typical symptoms of acute heart failure?
Symptoms include dyspnea, reduced exercise tolerance, ankle swelling, fatigue, pink frothy sputum, orthopnea, and paroxysmal nocturnal dyspnea.
What are some signs of pulmonary or systemic congestion in AHF?
Signs include fine basal crackles, peripheral edema, raised jugular venous pressure (JVP), hepatomegaly, gallop rhythm, and murmur.
What are signs of hypoperfusion in AHF?
Signs include hypoxia, tachypnea, tachycardia, cyanosis, cold and pale peripheries, oliguria, confusion, syncope, and narrow pulse pressure.
What conditions can be difficult to differentiate from acute heart failure (AHF) in older patients?
Asthma, chronic obstructive pulmonary disease (COPD), pneumonia, and pulmonary edema due to AHF can be difficult to differentiate, especially when they coexist.
What is the leading cause of AHF in patients without established chronic heart failure (CHF)?
Myocardial infarction is the leading cause of AHF in patients without established CHF.
What might unilateral basal crackles, especially when accompanied by cough and fever, indicate in a patient suspected of having AHF?
Unilateral basal crackles with cough and fever are more likely to indicate a chest infection, rather than AHF.
What should be considered if a patient presents with a global wheeze when diagnosing AHF?
If there is a global wheeze, asthma should be considered, although pulmonary edema associated with AHF can also present with wheezing.
What is the significance of BNP in AHF?
BNP is a sensitive but non-specific marker of hear failure. AHF is unlikely if BNP is less than 100 ng/litre or NT-proBNP is less than 300 ng/litre.
What imaging should be performed early in AHF patients, especially if cardiogenic shock is suspected?
An echocardiogram should be performed to assess biventricular function, valve disease, and other cardiac abnormalities.
What is the initial management approach for a patient with AHF?
Take an ABCDE approach, investigate the underlying cause, and involve senior support early. Look for CHAMP conditions (ACS, Hypertensive crisis, Arrhythmias, Mechanical problems, Pulmonary embolism).
What is the role of non-invasive ventilation (NIV) in AHF?
NIV, such as CPAP or BiPAP, is used for patients with cardiogenic pulmonary edema to improve ventilation and reduce respiratory distress.
