Green Book - Acute HF

Question 1

Investigations:

Answer 1

1. Bloods - FBC, U/E’s, LFTs, TFTs, fasting lipids, fasting glucose, troponin, BNP
2. ECG
3. CXR
4. ABG
5. Consider ECHO

Look at old ECHOs, Old data and old BP records

Question 2

BNP interpretation

Answer 2

1. <100 pg/ml: HF unlikely
2. 100-400 pg/ml: Refer for ECHO & specialist r/v within 6/52

**>400 **pg/ml: Refer for ECHO & specialist r/v within 2/52

Question 3

Factors Affecting BNP - Low BNP:

Answer 3

1. Obesity
2. Diuretics
3. ACE-I
4. ARBs
5. β-Blockers

Question 4

Factors Affecting BNP - Raised BNP:

Answer 4

1. LVH
2. Ischaemia
3. Tachycardia
4. RV overload
5. Hypoxaemia (including PE)
6. eGFR <60
7. Sepsis
8. COPD
9. DM
10. Liver cirrhosis
11. Age >70

Question 5

Mx of Haemodynamically unstable - Shock or respiratory failure:

Answer 5

1. Refer to cardiology SPR or OC consultant
2. Urgent Cardiology R/V:

Signs of ischaemia – Consider urgent Cathlab intervention
Consider inotropes
Urgent ECHO (same day)

3. ECHO showing LVSD
4. HF nurse input

Question 6

Mx of Haemodynamically stable with peripheral congestion:

Answer 6

1. IV furosemide 40-100mg bolus then BD (Monitor U&Es)
2. Minimum of their usual dose if already on diuretics

Question 7

Mx of Haemodynamically stable with peripheral congestion & Refractory oedema:

Answer 7

1. Higher dose Furosemide
2. Add in 2nd diuretic
3. Refer to cardiology
4. Maintain SBP >100 mmHg
5. Aim Sats >94%
6. Stop CCBs, NSAIDs, glitizone, sitagliptin
7. Rx any arrhythmias as per guidelines
8. Consider CPAP/NIV
9. Discussion with anaesthetists early

Question 8

Mx of Haemodynamically stable with no peripheral congestion:

Answer 8

1. GTN infusion 10-200mcg/min
2. IV morphine + anti-emetic
3. Small dose of IV furosemide 20mg
4. Refer to cardiology
5. Maintain SBP >100 mmHg
6. Aim Sats >94%
7. Stop CCBs, NSAIDs, glitizone, sitagliptin
8. Rx any arrhythmias as per guidelines
9. Consider CPAP/NIV
10. Discussion with anaesthetists early