Heart failure Flashcards
What are the signs of congestion in heart failure?
pulmonary congestion peripheral oedema Raised JVP hepatojugular reflex congested hepatomegaly ascites
What are the signs of hypoperfusion?
cold sweaty extremities oligouria mental confusion dizziness narrow pulse pressure
Patient with acute heart failure is given in oxygen and furosemide in ED. They continue to deteriorate. What do you do next?
Inotropes, vasopressors
Mechanical support- CPAP
Monitoring- level 2 care (CVC for inotropes, cardiac telemetry)
ECHO
Contact cardiologist, anaesthetist, ITU
Name one positive inotrope
noradrenaline
digoxin
How do vasopressors and inotropes differ?
inotropes improve cardiac contractility, while vasopressors act more specifically on contractility of blood vessels. Both however can increase blood pressure
What is the gold standard for assessing LV and RV function?
cardiac MRI
Which implantable devices are employed in heart failure?
Implantable ICD to manage dysrythmia
What is CRT and CRT-D?
CRT= Cardiac Resynchronization Therapy Pacemaker (CRT-P)
CRT-D= CRT + defibrillator
How is acute heart failure classified?
dry,wet, warm, cold
What is a classic sign of heart failure on CXR?
upper lobe diversion
Patient with heart failure symptoms, 84% sats not improving on O2, what do you do?
CPAP
Prior to commencing CPAP in heart failure patient, what must be ensured?
haemodynamically stable
CPAP increases intrathoracic pressure, reducing preload (reduction in pressure promotes venous return), reduced CO, hypotension
What is a normal ejection fraction?
50-65%
