Acute Left Ventricular Failure

Question 1

What are the triggers of acute LVF?

Answer 1

Iatrogenic e.g aggressive IV fluids
Sepsis
MI
Arrhythmias

Question 2

What symptoms does someone with acute LVF have?

Answer 2

Rapid onset SOB exacerbated by lying flat

Looking/feeling unwell

Cough (frothy white/pink sputum)

Question 3

What signs on examination would you see in someone with acute LVF?

Answer 3

Increased respiratory rate
Reduced O2 sats
Tachycardia
3rd heart sound
Bilateral basal crackles
Hypotension in severe cases (cardiogenic shock)

Question 4

What initial investigations would you do if suspecting acute LVF?

Answer 4

History
Examination
ECG to look for ischaemia and arrhythmias
ABG
CXR
Bloods (look for infection, kidney function, BNP, consider Troponin if suspecting MI)

Question 5

Above what percentage ejection fraction is considered normal?

Answer 5

Above 50%

Question 6

What fraction of the thorax should the heart size be under?

Answer 6

1/2

Question 7

What CXR findings would you see in heart failure?

Answer 7

ABCDE

A- Alveolar oedema (bat wing opacity)
B- kerley B lines
C- Cardiomegaly
D- Dilated upper lobe vessels
E- pleural Effusion

Question 8

What is the management of acute LVF?

Answer 8

Pour SOD

Pour away (stop) IV fluids
Sit up
Oxygen
Diuretics