Congestive Heart Failure (CHF)

Question 1

Congestive Heart Failure (CHF) - Definition

Answer 1

Impaired cardiac pump function leading to increased pulmonary pressure and pulmonary edema

Question 2

Goal of Care

Answer 2

Oxygenation, ventilation and transport to hospital

Question 3

Overview

Answer 3

CHF is often a chronic condition

Characterized by impaired cardiac pump function which causes blood to back up the systemic circuit, the pulmonary circuit or both

Question 4

Common Causes of Acute Exacerbation of CHF

Answer 4

• Failure to take necessary Rx
• Change in Rx
• AMI
• Hypertensive crisis
• Arrhythmia
• Renal failure
• Concomitant infection

Question 5

Guiding Principles

Answer 5

• Position pt to help facilitate decreased venous return. pts will have difficulty breathing laying supine and may suffer respiratory arrest if forced to lay down
• Support failing resps w/ postie pressure ventialtion
• Expedite transport early in pts w/ evvienc of MI
• CPAP has been proven an effective treatment for resp distress from multiple causes inclusing CHF/pulmonary edema
  
  • a secondary benefit of CPAP w/ CHF pts is the increased pressure in the airways results in an increased intra-thoracic pressure which may help decrease the volume of blood returning to the congested hear (preload)

Question 6

Acute Pulmonary Edema

Answer 6

• pts often have significant hypertension
• Ventolin may help with cardiac asthma however it is important to remember that wheeze in these cases is associated with edematous airways and not bronchospasm. This drug has sympathomimetic properties and so increases the workload of an already failing heart

**Some pts in pulmonary edema will become acutely worse when moved and require BVM ventilation

Question 7

Other Causes of Pulmonary Edema

Answer 7

• Toxic exposures - smoke, bleach and others
  These pts are usually not hypertensive, have no cardiac history and will give a hx of exposure
  the in-hospital treatment of these pt is different bu the principles of treatment in the field are the same w/ O2 and supportive ventilation if required, and rapid transport as necessary

Question 8

Intervention Guidelines - EMR/PCP

Answer 8

EMR
Keep pt at rest
Position pt sitting upright w/ legs dependent
Supp O2 
IPPV if required

PCP
All above, plus;
CPAP - mandatory CliniCall consult

Question 9

Intervention Guidelines - ACP

Answer 9

Treat hypertension
- Nitro 0.4mg SL as req’d

Reduce pain and anxiety
- Morphine - avoid if possible - 2.5mg IV q 2-3 to effect

Reduce airway pressure/bronchodilate
- 5mg neb w/ O2 - repeat as necessary

Intubation

12 lead ECG

Rapid hospital notification of STEMI

Correct rhythm disturbance

• Symptomatic Bradycardia
• Symptomatic Narrow Complex Tachycardia
• Symptomatic Wide Complex Tachycardia

Question 10

Further Care

Answer 10

• Fibrinolytic therapy / PCI
• CPAP - BiPAP
• Mechanical ventilation
• IV Nitro
• Pressor agents - Dopamine or Dobutamine
• Antiarrythmic therapy and rate control
• Intra-aortic balloon pump
• Surgical intervention