Cardiac failure Flashcards
Acute left ventricular failure
Left ventricle unable to adequately move blood through the left side of the heart and out into the body
Triggers
Iatrogenic (aggressive IV fluids in frail elderly patients with impaired LVF)
Sepsis
MI
Arrhythmias
Symptoms of acute LVF
Rapid onset breathlessness
- exacerbated by lying flat and improves on sitting up
Looking/ feeling unwell
Cough (frothy white/pink sputum)
Acute LVF on examination
Increased RR
Reduced O2 sats
Tachycardia
3rd heart sound
Bilateral basal crackles
Hypotension in severe cases
Blood gas for acute LVF
Type 1 respiratory failure
- low oxygen without increase in carbon dioxide
Signs/symptoms if they also have right sided failure
Raised JVP
Peripheral oedema
BNP
Hormone released from the ventricles when the myocardium is stretched beyond the normal range
Action of BNP
Relax smooth muscle in blood vessels
Reduces systemic vascular resistance making it easier for the heart to pump blood through the system
Acts on kidneys as a diuretic to reduce circulating volume and improve function of heart
Other causes of raised BNP
Tachycardia
Sepsis
PE
Renal impairment
COPD
Use of ECHO
To measure left ventricular function by the ejection fraction
Normal ejection fraction
Above 50%
Chest xray findings
Cardiothoracic ratio >0.5
Upper lobe venous diversion
Bilateral pleural effusions
Fluid in interlobular fissures
Fluid in septal lines (Kerley lines)
Management of acute LVF
Pour SOD
Pour away (stop) their fluids
Sit up
Oxygen if <95%
Diuretics
Other management if severe acute pulmonary oedema or cardiogenic shock
IV opiates (act as vasodilators but not routinely recommended)
NIV (CPAP helps open airways to improve gas exchange)
If NIV doesn’t work they made need full intubation and ventilation
Inotropes to strengthen force of heart contractions
Presentation of chronic heart failure
Breathlessness worsened by exertion
Cough (frothy white/ pink sputum)
Orthopnoea
PND
Peripheral oedema
Paroxysmal nocturnal dyspnoea
Waking and feeling short of breath with a cough and wheeze
Fluid settling across large surface area as lying flat
Respiratory centres in brain become less responsive so RR and effort doesn’t increase in response to reduced O2 like it would awake
Causes of chronic heart failure
IHD
Valvular heart disease
HTN
Arrhythmias
Additional management for chronic heart failure patients
One off pneumococcal vaccine
Annual flu vaccine
Stop smoking
First line medical management of chronic HF
ACEi and beta blocker
Second line treatment
Aldosterone antagonist
Need to monitor potassium
Third line treatment
Ivabradine
Salcubitril-valsartan
Digoxin
Hydralazine combination with nitrate
Cardiac resynchronisation therapy
Ivabradine criteria
Sinus rhythm >75bpm and LVF <35%
Sacubitril-valsartan criteria
LVF <35%
Considered in HF with reduced ejection fraction who are symptomatic on ACEi or ARBs
Digoxin use
Not been proven to reduce mortality in patients with HF
May improve symptoms due to inotropic properties
Strongly indicated if co-existant af
Hydralazine indication
Afro-Caribbean patients
Cardiac resynchronisation therapy indication
Widened QRS complex on ECG
