Acute Heart Failure Flashcards

1
Q

What is acute heart failure?

A

A medical emergency, with left or right heart failure developing over minutes or hours

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2
Q

What additional initial investigations are required in acute heart failure?

A
  1. Serum troponin
    - Myocardial necrosis
  2. D-dimer
    - PE

In addition to the usual CXR, bloods, ECG

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3
Q

List the 6 clinical syndromes defined for acute heart failure and describe the features of each

A
  1. Acute decompensation of chronic heart failure
  2. Hypertensive heart failure
    - High BP
    - Preserved LV function
    - Pulmonary oedema on CXR
  3. Acute pulmonary oedema
    - Acutely breathless, tachycardic, sweaty (sympathetic overactivity)
    - Wheezes and crackles throughout chest
    - Hypoxia
    - CXR features
  4. Cardiogenic shock
    - Hypotension
    - Tachycardia
    - Oliguria
    - Cold extremities
  5. High output cardiac failure, e.g. septic shock
    - Warm peripheries
    - Pulmonary congestion
    - BP may be low
  6. Right heart failure
    - Low CO
    - Elevated JVP
    - Hepatomegaly
    - Hypotension
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4
Q

True or false: in acute heart failure, treatment may begin before investigations are completed

A

True - patients are often too unwell to wait for Ix results

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5
Q

True or false: in acute heart failure, patient are managed in HDU

A

True - require invasive procedures for monitoring and to direct therapy

  • Central venous cannulation
  • Arterial lines
  • Pulmonary artery cannulation
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6
Q

True or false: in acute heart failure, all patients require prophylactic anticoagulation

A

True - e.g. enoxaparin

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7
Q

What initial therapy is given to patients with acute heart failure?

A
  1. High flow oxygen
    - CPAP may be indicated
  2. Diuretics
    - Furosemide IV 50 mg
  3. Vasodilators
    - GTN IV 50 mg in 50 mL saline at 2-10 mL/h
    - Only if SBP is > 85 mmHg
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8
Q

What therapy can be added in patients with acute heart failure who do not respond to initial therapy?

A

Inotropic support, e.g. dobutamine

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9
Q

A patient comes in with acute heart failure with systolic dysfunction. Following initial therapy her SBP is 110 mmHg. How do you proceed?

A

Vasodilators

  • GTN, nitroprusside, BNP
  • e.g. GTN IV 50 mg in 50 mL saline at 2-10 mL/h
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10
Q

A patient comes in with acute heart failure with systolic dysfunction. Following initial therapy her SBP is 90 mmHg. How do you proceed?

A

Vasodilator and or inotrope

  • GTN, nitroprusside, BNP
  • dobutamine, PDEI
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11
Q

A patient comes in with acute heart failure with systolic dysfunction. Following initial therapy her SBP is 75 mmHg. How do you proceed?

A
  1. Volume load?

2. Inotrope / dopamine / noradrenaline

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12
Q

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?

A

Consider mechanical assist device, e.g. right or left or bi-ventricular assist devices.

If good response, continue long-term oral therapy: furosemide, ACEI

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