Cardiac failure (acute and chronic)

Question 1

Acute heart failure management

Answer 1

Acute heart failure presents with R sided failure- Oedema, fluid overload etc- the risky part is from the pulm oedema

SIT PT UP
Give IV loop diuretics- Furosemide (or increase dose

on top can give -oxygen
IV Nitrates/vasodilator- especially if concomittant with MI, HTN, Valvular disease
(ofc care of SE- Hypotension)

and if resp failure- CPAP

Pt with hopotension/cardiogenic shock– as loop/Nitrates woll make worse
give- Ionotropic agents (eg dobutamine)
Vasopressor (norepinephrine)

dont give opiates

Question 2

Acute heart failure investigation and presentation

Answer 2

Present with R sided failure- fluid overlaod, SOB, pulm oedema
on exam- oedematour, gallop rythme, hypo/hypertense

ECG- can have anything
CXR- ABCDE- Alveolar shadow (bat wing), Kerley B line), Cardiomegaly, dilated upper vessels, Effusion
BT- BNP under 100 means its not/or NTBNP under 300
POC Echo-do within 24h for management

echo- calculate ejection fraction- <40 is reduced, >50% is maintained

Question 3

Heart failure chornic presentation and Ix

Answer 3

Often present with acute signs, and then diangoses

if not-
SOB at rest or with exercise
increased number of pillows at night
Weight gain/swelling of legs

NYClassification
I Heart disease present, but no undue dyspnoea from ordinary activity.

II Comfortable at rest; dyspnoea on ordinary activities.

III Less than ordinary activity causes dyspnoea, which is limiting.

IV Dyspnoea present at rest; all activity causes discomfort.

RF- MI, previous ischemia, HTN, valvular disease, congenital

ECG- can have anything
CXR- ABCDE- Alveolar shadow (bat wing), Kerley B line), Cardiomegaly, dilated upper vessels, Effusion
BT- BNP under 100 means its not/or NTBNP under 300
POC Echo-do by specialist for echo
CMRI can be used if echo hard etc

Question 4

Management of chronic heart failure with preserved ejection fraction

Answer 4

many drugs

life lengthening-
ACEi/ARB, Bblocker, SPirolactone

For Sx0 Furosemide

Question 5

Management of chronic heart failure with reduced ejection fraction

Answer 5

many drugs

1st line- Acei and Bblock
2nd-Aldosterone antagonist, ARB, Hydralazine (for africanamericans)

life lengthening-
ACEi/ARB, Bblocker, SPirolactone
DAPAGLIFOZIN/EMPAGLIFOZIN

For Sx- Furosemide
Lifestyle- salt restict, stop smoke

then for specialist- Ivabradine, Sacubitril Valsartan, Hydralazin
When worsen- digoxin

AVOID cardiac CCB