Acute LVF and Pulmonary Oedema

Question 1

What is acute left ventricular failure?

Answer 1

left ventricle not able to adequately move blood which causes a backlog

Question 2

How can acute LVF lead to pulmonary oedema?

Answer 2

• Backlog of blood into left atrium, pulmonary vein and lungs
• vessels begin to leak fluid due to increased volume and pressure
• lung tissue and alveoli become full of interstitial fluid (pulmonary oedema)

Question 3

What does pulmonary oedema cause?

Answer 3

• interferes with gas exchange

- causing shortness of breath and oxygen desaturation

Question 4

What can trigger acute LVF?

Answer 4

• Iatrogenic (IV fluids in elderly patients with impaired LV function)
• Sepsis
• MI
• Arrhythmias

Question 5

How would acute LVF present?

Answer 5

• Rapid onset breathlessness
• exacerbated by lying flat
• low oxygen without increase in CO2 in blood (type 1 respiratory failure)
• cough (frothy white/pink sputum)
• Look + feel unwell

Question 6

What could be seen on examination of acute LVF patient?

Answer 6

• inc respiratory rate
• reduced O2 sat
• Tachycardia
• 3rd heart sound
• bilateral basal crackles on auscultation
• hypotension (can cause cariogenic shock)

Question 7

What signs and symptoms can be sign in patients with acute LVF due to underlying causes?

Answer 7

• Chest pain in acute coronary syndrome
• fever in sepsis
• palpitations in arrhythmias

Question 8

What would you find on examination of a patient who also had right sided HF?

Answer 8

• raised JVP

- peripheral oedema

Question 9

What medication can be given to clear fluids?

Answer 9

Furosemide

Question 10

What will the work up of patient with acute LVF include?

Answer 10

• History
• CV examination
• ECG (check for arrhythmias and ischaemia)
• Arterial blood gas
• Chest Xray
• Bloods

Question 11

What can blood tests tell you about a patient with acute LVF?

Answer 11

Cause of LVF i.e.

• infection
• BNP and troponin if MI
• kidney function

Question 12

What is BNP and when is it released?

Answer 12

• B-type Natriuretic peptide
• Released by heart ventricles when myocardium stretched beyond normal
• so high BNP = heart overload with blood

Question 13

What are the causes of raised BNP?

Answer 13

• Tachycardia
• Sepsis
• Pulmonary embolism
• renal impairment
• COPD

Question 14

Are BNP levels to check for acute LVF sensitive or specific?

Answer 14

sensitive but not specific i.e. can rule out HF but can’t confirm

Question 15

What does release of BNP accomplish?

Answer 15

• relaxes smooth muscles in blood vessels
• reduces systemic vascular resistance
• acts as diuretic on kidneys to reduce blood volume
• easier for heart to pump

Question 16

What can an ECG tell you in patients with acute LVF?

Answer 16

• Assess left ventricular function
• ejection fraction main measure of LV function
• below 50% = abnormal

Question 17

What can be seen in CXR patient with acute LVF?

Answer 17

• Cardiomegaly
• upper lobe diversion
• Bilateral pleural effusion
• fluid in interlobar fissures
• fluid in the septal lines

Question 18

What is the definition of cardiomegaly?

Answer 18

• cardiothoracic ratio of more than 0.5

- diameter of heart more than 50% of thoracic cavity

Question 19

What is venous diversion?

Answer 19

• Usually when standing lower lobe veins in lungs contain more blood and upper veins remain small
• In LVF upper lobe veins also full and become engorged
• visible as increased prominence and diameter

Question 20

What CXR findings are caused by oedematous lung tissues?

Answer 20

• Bilateral pleural effusions
• Fluid in interlobar fissures
• Fluid in the septal lines (Kerley lines)

Question 21

How are acute LVFs managed (Pour SOD)?

Answer 21

• Pour away IV fluids
• Sit up (fluid fall to bottom of lungs leaving upper lobes able to gas exchange)
• Oxygen
• Diuretics
• monitor fluid balance (measure intake, urine and U&Es)

Question 22

What other management strategies can be used in patients with sever pulmonary oedema and cariogenic shock?

Answer 22

• Intravenous opiates (vasodilators)
• Non-invasive ventilation and continuous positive airway pressure (air forcefully blown into lungs using tight fitted mask, helps open airways)
• Inotropes e.g. noradrenaline (strengthen force of heart contraction)