cardiac failure guidelines Flashcards
precipitants of heart failure
- acute (6)
- non acute (4)
acute
- arrhythmia
- myocardial infarction
- mechanical catastrophe - valvular rupture, interventricular septum rupture
- pericardial effusion
- pulmonary embolism
- hypertensive crisis
non-acute
- alcoholic cardiomyopathy
- drugs (cocaine, amfetamine)
- haemochromatosis
- chronic lung disease -> cor pulmonale
acute cardiogenic pulmonary oedema - management
- prehospital (3)
- initial hospital ED / CCU (5)
broadly, think under the banners of
fluid control - diuretics, IDC
vasodilation - opioids, GTN
ventilation support - O2, CPAP
prehospital
- furosemide IV 40mg stat
- high flow O2 targeting SaO2 > 94%
- consider GTN 400microg SL stat if SBP > 100
hospital
- IV furosemide 20-80mg, repeat at 20 minutes
- GTN infusion 10 microg/minute if SBP >100
- morphine IV 1-2.5mg single dose
- IDC insertion to monitor urine output
- consider CPAP
left heart failure symptoms (2)
pulmonary congestion
dyspnoea
right heart failure symptoms (3)
elevated venous pressure (JVP)
peripheral oedema
liver congestion
what is congestive heart failure
L + R heart failure
chronic heart failure management - nonmedical (6)
intake
- fluid restriction 1.5 L per day
- salt restriction targeting > 2g/day
daily activities
- daily weight monitoring
- sleep on an incline if nocturnal dyspnoea symptoms are a problem
referrals
- exercise physiologist referral for cardiac rehabilitation
- cardiology referral
chronic heart failure management
- initial medications and dosages (4)
ACE inhibitor - perindopril arginine 2.5mg PO OD
beta-blocker - bisoprolol 1.25mg PO OD
spironolactone 25mg PO OD
loop diuretic - frusemide 20-40mg PO OD
chronic heart failure management
- which one should not be used in acute decompensation
- don’t use beta blocker when acutely decompensated
chronic heart failure management
- which medications reduce morbidity and mortality
- b-blocker, spironolactone, ACE-I reduce morbidity and mortality
