Congestive heart failure Flashcards
Etiology
Coronary artery disease Hypertension Valvular disease Myocarditis Infiltrative Congenital heart disease Pericardial Drugs DM, thyroid, acromegaly SLE, RA Chemotherapy Nutritional Pregnancy Familial cardiomyopathy
Risk factors
MI DM Dyslipidemia Old age Male HTN Cocaine Cardiotoxic agents Renal VHD FHx AFIB Thyroid
Investigations
- Transthoracic echo
- ECG->evidence of underlying CAD, LVH, atrial enlargement, conduction
- CXR
- BNP
- FBC->etiologies, exacerbation of HF
- UEC->hyponatremic
- Cr/urea
- Blood glucose
- LFTs
- TFTs->hyper/hypothyroidism
- Blood lipids
Management
- ACEi
- Sodium restriction + fluid restriction + weight monitoring + continuous health screening + exercise + AHD + Care plan
- Beta blocker
- ARB
- Hydralazine + isosorbide dinitrate
- Frusemide
- Digoxin (w/ AFIB)
- ICD
- Transplant
Patient instructions on discharge
Home weight monitoring Sodium restriction Tobacco and alcohol discontinuation Aggressive control of HTN and diabetes Lipid management Regular, symptom limited exercise Routine health-care maintenance
Criteria for diagnosis
Clinical
2 major or 1 major and 2 minor
Major: NVD Rales Acute pulmonary edema S3 gallop \+venous pressure Circulation >25 seconds HJ reflux Cardiomegaly PND, or orthopnea
Minor: Ankle edema Night cough Dyspnea on exertion Hepatomegaly Pleural effusion 120
Weight Loss >4.5kg in 5 days in response to treatment
Management of acute cardiac failure
ABC, IV access, ECG monitoring Oxygen Morphine + metoclopramide Frusemide Glyceryl trinitrate Supportive care->maintain oxygen, fluid/salt/weight Ventilation Organise echoC Admit Regular observations
If hypotensive: ionotrope/vasopressor, omit frusemide and vasodilator, need urinary catheter
Due to:
a. ischemia->aspirin, clopidogrel, revascularisation
b. Valvular->Nitropursside
c. If hypertensive crisis->will need IV beta blockers and GTN +/- nitroprusside
Management of acute HF following stabilisation
ACE Beta blocker ARB Vasodilator Diuretic Dogoxin Ivarabine Supportive care
Precipitants of acute CF
Decompensation of pre-existing
Medication non-compliance
HTN crisis
Arrythmia, regurgitation, stenosis, myocarditis, tamponade, dissection, fluid overload, surgery, renal failure, phaeochromC, ++Output->sepsis, anemia, thyrotoxic crisis, anemia, shunt
