Acute Heart Failure Flashcards
What is acute heart failure?
A medical emergency, with left or right heart failure developing over minutes or hours
What additional initial investigations are required in acute heart failure?
- Serum troponin
- Myocardial necrosis - D-dimer
- PE
In addition to the usual CXR, bloods, ECG
List the 6 clinical syndromes defined for acute heart failure and describe the features of each
- Acute decompensation of chronic heart failure
- Hypertensive heart failure
- High BP
- Preserved LV function
- Pulmonary oedema on CXR - Acute pulmonary oedema
- Acutely breathless, tachycardic, sweaty (sympathetic overactivity)
- Wheezes and crackles throughout chest
- Hypoxia
- CXR features - Cardiogenic shock
- Hypotension
- Tachycardia
- Oliguria
- Cold extremities - High output cardiac failure, e.g. septic shock
- Warm peripheries
- Pulmonary congestion
- BP may be low - Right heart failure
- Low CO
- Elevated JVP
- Hepatomegaly
- Hypotension
True or false: in acute heart failure, treatment may begin before investigations are completed
True - patients are often too unwell to wait for Ix results
True or false: in acute heart failure, patient are managed in HDU
True - require invasive procedures for monitoring and to direct therapy
- Central venous cannulation
- Arterial lines
- Pulmonary artery cannulation
True or false: in acute heart failure, all patients require prophylactic anticoagulation
True - e.g. enoxaparin
What initial therapy is given to patients with acute heart failure?
- High flow oxygen
- CPAP may be indicated - Diuretics
- Furosemide IV 50 mg - Vasodilators
- GTN IV 50 mg in 50 mL saline at 2-10 mL/h
- Only if SBP is > 85 mmHg
What therapy can be added in patients with acute heart failure who do not respond to initial therapy?
Inotropic support, e.g. dobutamine
A patient comes in with acute heart failure with systolic dysfunction. Following initial therapy her SBP is 110 mmHg. How do you proceed?
Vasodilators
- GTN, nitroprusside, BNP
- e.g. GTN IV 50 mg in 50 mL saline at 2-10 mL/h
A patient comes in with acute heart failure with systolic dysfunction. Following initial therapy her SBP is 90 mmHg. How do you proceed?
Vasodilator and or inotrope
- GTN, nitroprusside, BNP
- dobutamine, PDEI
A patient comes in with acute heart failure with systolic dysfunction. Following initial therapy her SBP is 75 mmHg. How do you proceed?
- Volume load?
2. Inotrope / dopamine / noradrenaline
A patient comes in with acute heart failure with systolic dysfunction. Following initial therapy her SBP is 85 mmHg so a vasodilator and inotrope are given. However there is no response. How do you proceed?
Consider mechanical assist device, e.g. right or left or bi-ventricular assist devices.
If good response, continue long-term oral therapy: furosemide, ACEI