Emergency Treatment of Cardiac Failure/Pulmonary Oedema

Question 1

What is this a presentation of?
Dyspnoea, orthopnoea, pink frothy sputum. Distressed, pale, sweaty, tachycardic, tachypnoeic, raised JVP, fine lung crackles, S3 gallop, wheeze. Sitting up and leaning forwards.

Answer 1

Acute decompensated heart failure

Question 2

What blood tests should you request in someone with suspected acute decompensated heart failure, and what results would make the diagnosis likely in these age groups?

1. <50
2. 50-75
3. > 75

Answer 2

NT-proBNP and U&Es
1. >450
2. >900
3. >1800
Echo to confirm or if unsure.

Question 3

What is the management of acute decompensated heart failure?

Answer 3

1. Pulse, sats, BP, ECG, CXR, FBC, U&Es, NT-proBNP, TFTs, LFTs, troponin, glucose, lipids, IV access.
2. Call cardiology SpR to admit to CCU
3. Oxygen to maintain 94-98%
4. IV furosemide 40-80mg bolus, then 5-20mg/hr infusion if required.
5. Consider IV GTN infusion in myocardial ischaemia, severe HTN, or valve disease.
6. Maintain systolic >100mmHg
7. Daily weights, aim 0.5kg/day reduction, CPAP if medical therapy fails.