Heart failure Flashcards
triggers of acute left ventricular failure?
iatrogenic (aggressive IV fluids in elderly with impaired left ventricular function)
MI
arrhythmias
sepsis
hypertensive emergency
Acute LVF causes?
type 1 respiratory failure, low oxygen without an increase in carbon dioxide
symptoms of lvf?
sob, looking unwell, cough with frothy white or pink sputum, sob worse when lying flat
signs of acute lvf?
tachycardia, raised resp rate, reduced oxygen sats, 3rd heart sound, bilateral basal crackles, hypotension, displaced apexbeat, cyanosis, elevated jvp
in right sided heart failure you would find?
raised jvp, peripheral oedema
why is BNP released?
released from ventricles when myocardium is stretched beyond the normal range.
action of BNP?
relax smooth muscle in blood vessels, diuretic to promote water excretion
BNP can be raised?
heart failure. >100mg/l
tachycardia
sepsis
PE
renal impairment
COPD
CXR for heart failure?
cardiomegaly >0.5
upper lobe venous diversion - increased diameter
bilateral pleural effusions
interlobar fissures fluid
kerley lines
management of acute LVF?
sit up
oxygen
diuretics iv furosemide
IV fluids stopped
underlying causes
monitor fluid balance
severe cases of LVF require?
Intravenous opiates, such as morphine, which act as vasodilators
Intravenous nitrates act as vasodilators, and may be considered in severe hypertension or acute coronary syndrome
Inotropes, such as dobutamine, to improve cardiac output
Vasopressors, such as noradrenalin, to improve blood pressure
Non‑invasive ventilation
Invasive ventilation (involving intubation and sedation)
de-novo heart failure is caused by?
increased cardiac filling pressures and myocardial dysfunction, due to ischaemia. this will cause reduced cardiac output and hypoperfusion, which will result in pulmonary oedema. other causes are viral myopathy, toxins, valve dysfunction
causes of decompensated heart failure?
ACS, acute arrhythmia, hypertensive crisis, valvular disease
when not to give vasodilators?
hypotension
when do vasodilators have a role?
concomitant myocardial ischaemia, sever hypertension, regurgitant aortic or mitral valve disease
how should patients with respiratory failure be treated?
CPAP
How to treat patients with cardiogenic shock, hypotension <85mmHg?
inotropic agents dobutamine (severe left ventricular dysfunction), vasopressor agents norepinephrine (if ionotropes dont work/ end organ hypoperfusion, mechanical circulatory assisstance intra aortic balloon counterpulsation
when should beta blockers be stopped in heart failure?
less than 50 beats per minute, second or 3rd degree atrioventricular block, shock
heart failure with reduced LVEF is?
<35 to 40%
usually people with HF-rEF have?
systolic dysfunction whereas HF-pEF have diastolic dysfunction
systolic dysfunction is?
ischaemic heart disease
dilated cardiomyopathy
myocarditis
arrhythmia
diastolic dysfunction is due to?
hypertrophic obstructive cardiomyopathy
restrictive cardiomyopathy
cardiac tamponade
constrictive pericarditis
left ventricular failure results in?
pulmonary oedema, dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, bibasal fine crackles.
right ventricular failure results in?
peripheral oedema
raised jvp
hepatomegaly
anorexia
weight gain
