Acute LVF and Pulmonary Oedema Flashcards
What is acute left ventricular failure?
What does it lead to?
Common - occurs when the left ventricle is unable to adequately move blood through the left side of the heart and out into the body –>
causes a backlog of blood that increases the amount of blood stuck in the left atrium, pulmonary veins and lungs. As the vessels in these areas are engorged with blood they leak fluid and are unable to reabsorb fluid from the surrounding tissues. This causes pulmonary oedema, which is where the lung tissues and alveoli become full of interstitial fluid. This interferes with the normal gas exchange in the lungs, causing shortness of breath, oxygen desaturation and the other signs and symptoms.
What causes acute LVF?
Iatrogenic (e.g. aggressive IV fluids in frail elderly patient with impaired left ventricular function)
Sepsis
Myocardial Infarction
Arrhythmias
Presentation of acute LVF?
Acute LVF associated with?
Symptoms?
Acute LVF typical presents as a rapid onset breathlessness. This is exacerbated by lying flat and improves on sitting up. Acute LVF causes a type 1 respiratory failure (low oxygen without an increase in carbon dioxide in the blood).
Symptoms:
Shortness of breath
Looking and feeling unwell
Cough (frothy white/pink sputum)
Examination of patient with acute LVF?
Increased respiratory rate
Reduced oxygen saturations
Tachycardia
3rd Heart Sound
Bilateral basal crackles (sounding “wet”) on auscultation
Hypotension in severe cases (cardiogenic shock)
Signs and symptoms of acute LVF related to underlying cause?
Chest pain in ACS
Fever in sepsis
Palpitations in arrhythmias
If they also have right sided heart failure you could find:
Raised Jugular Venous Pressure (JVP) (a backlog on the right side of the heart leading to an engorged jugular vein in the neck) Peripheral oedema (ankles, legs, sacrum)
Nurse has asked you to review a patient that has just started desaturating…
TOM TIP: When you are on the wards and a nurse asks you to review a patient that has just started desaturating ask yourself how much fluid that patient has been given and whether they might not be able to process that much. For example, an 85 year old lady with chronic kidney disease and aortic stenosis is prescribed 2 litres of fluid over 4 hours and then starts to drop her oxygen saturations. This is a common scenario and a dose of IV furosemide can often work like magic to clear some fluid and ease their breathing.
Investigation for acute LVF?
History
Clinical Examination
ECG (to look for ischaemia and arrhythmias)
Arterial Blood Gas (ABG)
Chest Xray
Bloods (routine bloods for infection, kidney function, BNP and consider troponin if suspecting MI)
If the clinical presentation is acute LVF then treat before having the diagnosis confirmed by BNP or echo. Without treatment they can deteriorate before getting the investigations.
What is BNP?
