Acute Heart Failure, E and D Flashcards
What is an acute heart failure
- an abrupt onset, rapid progression, with no time for compensatory mechanisms to take place
- is a medical emergency, with a high risk of death
Acute HF: E
- CAD: Coronary artery heart diseases -> ischemic heart diseases: Stable angina, Unstable angina, MI
- ACS: Acute coronary syndrome: MI, unstable angina
- Acute decompensated Chronic HF
- HTN and arrhythmia
- valvular disease
- endocarditis
- dissection
- cardiomyopathy
- non cardiac origins: sepsis, anemia, tamponade, PE, shunt thyrotoxicosis
Acute HF: Signs and symptoms
- RHF: distended neck veins, portal HTN, hepatomegaly, peripheral edema, epistaxis, nocturia, ascites
- LHF: pulmonary congestion/oedema, dyspnea, cough, wheezing, blood in sputum, fatigue, cold extremities
Acute HF: Diagnosis
- history
- medical examination
- ECG
- CXR
- ABG: arterial blood gases
- blood test: NBP
Classification: Killip classification
The Killip classification is widely used in patients presenting with acute MI for the purpose of risk stratification:
- Class I: no clinical signs of heart failure
- Class II: rales or crackles, no gallop, elevated jugular venous pressure
- Class III: frank acute pulmonary edema
- Class IV: cardiogenic shock
What to do with an acute heart failure patient ?
- aim: to optimize the oxygenation and tissue perfusion, through IV access, and monitoring (invasive if needed)
Steps: - positioning the patient: sitting or half-sitting (45°)
- evaluation and control of fluid (volume) state of the patient (stop of infusion in case of left heart failure)
- symptom guided treatment
- etiology evaluation and causal treatment
- fluid control
Identification of acute HF aetiology
"CHAMP" C: acute Coronary syndrome H: Hypertension emergency A: arrhythmia M: acute mechanical cause P: pulmonary embolism
What to do with a patient suspected of AHF
- Does the patient have a cardiogenic shock ?
.NO -> respiratory failure ? NO -> good - Does the patient have a cardiogenic shock ?
.YES -> circulatory support: pharmacological, mechanical -> immediate stabilization and transfer to ICU/CCU - Does the patient have a Cardiogenic shock ?
.NO -> respiratory failure ? yes -> ventilatory support: Oxygen, non-invasive positive pressure ventilation, mechanical ventilation -> immediate stabilization and transfer to ICU/CCU
Acute decompensated heart failure (ADHF), what is it
- a sudden worsening of the signs and symptoms of heart failure
Acute decompensated heart failure (ADHF): Signs and symptoms
- difficulty breathing (dyspnea), can cause acute respiratory distress
- leg or feet swelling
- fatigue
Acute decompensated heart failure (ADHF): E
- chronic stable heart failure, can easily decompensated.
- Intercurrent illness: pneumonia
- myocardial infarction (heart attack)
- abnormal heart rhythms: A-fib
- uncontrolled high BP
- person’s failing to maintain a fluid restriction, diet or medication
- anemia
- hyperthyroidism
- anything causing fluid retention: medication, excessive fluid intake, salt intake, NSAIDs, Thiazolidinediones
Forrester’s hemodynamic stages:
Is used to determine the treatment strategy regarding an acute HF.
Depends on cardiac index and pulmonary capillary wedges pressure (PWCP).
Cardiac index (parameter that relates the cardiac output (CO) from left ventricle in one minute to body surface area ) allows to determine the degree of perfusion, classifying as cold or warm.
Cold -> perfusion is less than 2,2 l/min/m2
Warm -> perfusion is more than 2,2 l/min/m2
Pulmonary capillary wedges pressure (PWCP), determines the fluid state. Uses the left ventricular end-diastolic pressure.
If LVEDP > 18mmHg -> wet
If LVEDP < 18mmHg -> dry
In case of Warmness -> favor diuretics: furosemide
In case of coldness -> favor vasodilators: nitroglycerin, nesitritide, nitroprusside
In case of Wetness ->
In case of Dryness -> inotropic drugs: Dobutamine, Milrinone
