acute heart failure and pulmonary oedema

Question 1

When the left ventricle is not functioning properly, where does blood backup to?

Answer 1

the left atrium, pulmonary veins and lungs

Question 2

What is pulmonary oedema?

Answer 2

when the lung tissue and alveoli become full of interstitial

Question 3

What are the triggers of cute LHF?

Answer 3

iatrogenic (aggressive IV fluids in frail elderly patient)
sepsis
MI
arrhythmias

Question 4

How does acute LVF present?

Answer 4

rapid onset breathlessness

exacerbated by lying flat and improves on sitting up

Question 5

What type of respiratory failure does acute LVF cause?

Answer 5

type 1

Question 6

what are the symptoms of acute LVF?

Answer 6

shortness of breath
looking and feeling unwell
cough (frothy white / pink sputum)

Question 7

What will be found on examination in LVF?

Answer 7

increased respiratory rate
reduced sats
tachycardia 
3rd heart sound
bilateral basal crackles 
hypotension in severe cases (cariogenic shock)

Question 8

What other signs and symptoms related to the underlying cause of LVF might there be?

Answer 8

chest pain in ACS
fever in sepsis
palpitations in arrhythmias

Question 9

What might be found if they also have right sided heart failure?

Answer 9

raised JVP

peripheral oedema

Question 10

What is the workup for LVF?

Answer 10

history 
clinical examination 
ECG (ischaemia and arrhythmias)
ABGs
Chest Xray 
bloods (infection, kidney function, BNP and consider troponin if suspected MI)

Question 11

When is BNP released?

Answer 11

When the cardiac muscle is stretched beyond the normal range - a high result indicates the heart is overloaded beyond its normal capacity to pump effectively

Question 12

What are the actions of BNP?

Answer 12

relaxes smooth muscle in blood vessels (reduces systemic vascular resistance)
Acts as a diuretic on the kidneys

Question 13

Apart from heart failure, what can lead to a raised BNP?

Answer 13

tachycardia
sepsis
pulmonary embolism
renal impairment
COPD

Question 14

What is the ejection fraction?

Answer 14

the percentage if the biked in the left ventricle which is squeezed out with each ventricular contraction (>50% is normal)

Question 15

How is cardiomegaly defined?

Answer 15

A cardiothoracic ratio of more than 0.5

the diameter of the widest part of the heart is more than half the diameter of the widest part of the lung fields

Question 16

What are the main X-ray findings in heart failure?

Answer 16

cardiomegaly 
upper lobe venous diversion
bilateral pleural effusions
fluid in interlobar fissures
fluid in septal lines (kerley lines)

Question 17

What is the management of acute LVF?

Answer 17

POUR SOD
Pour away (stop IV fluids)
Sit up
oxygen (if <95%, caution with COPD)
Diuretics (IV furosemide 40mg stat)
MOnitor fluid balance

Question 18

What other options can be used in severe acute pulmonary oedema or cardiogenic shock?

Answer 18

IV opiates
Non-invasive ventilation, Continuous positive airway pressure
Inotropes - noradrenaline