Heart failure Flashcards
What are some triggers for acute LVF?
Iatrogenic - e.g. aggressive IV fluids in elderly patients with impaired ventricular function
Sepsis
MI
Arrhythmias
How may a patient with acute LVF present?
Shortness of breath
Unwell
Cough with frothy white/pink sputum
What clinical signs may be present in acute LVF?
Increased RR Reduced SaO2 Tachycardia 3rd Heart sound Basal crackles Hypotension in severe cases (Cardiogenic shock)
May find signs and symptoms related to underlying cause:
Chest pain in ACS
Fever in sepsis
Palpitations in arrhythmias
What investigations should be carried out in CCF?
1st line = NT-proBNP - raised in CCF
Bloods:
FBC - look for anaemia
U&Es - look for renal failure, electrolyte abnormalities due to fluid overload (e.g. hyponatraemia)
LFTs - look for hepatic congestion
TFTs - look for hyper/hypothyroidism
Lipids profile/HbA1c - risk of atherosclerosis
Troponin - look for signs of recent MI
Urinalysis:
Glycosuria - look for diabetes
Leukocytes/nitrates - look for urosepsis
Protein/blood - look for renal failure
Echo
CXR - signs of CCF
ECG - look for previous MI and arrhythmia
How is acute CCF managed?
POUR SOD: Pour away (stop) their IV fluids Sit up Oxygen - if SaO2 <95% Diuretics - IV furosemide 40mg stat
Also: Opiates Vasodilators Inotropic agents - e.g. noradrenaline CPAP Ultrafiltration
Monitor fluid balance:
Measure fluid intake AND urine output
U&Es
Daily body weight
What signs are present in RVF?
Raised JVP Peripheral oedema Ascites Nausea Anorexia Epistaxis Facial engorgement (swelling)
What clinical findings can be seen on CXR in CCF?
A - alveolar oedema (perihilar/bat-wing opacification)
B - kerley B lines (interstitial oedema)
C - cardiomegaly (cardiothoracic ratio >50%)
D - dilated upper lobe vessels
E - effusion (e.g. pleural effusion - blunted costophrenic angles with meniscus sign)
What is B-type natriuretic peptide (BNP)?
BNP is a hormone produced mainly by the left ventricular myocardium in response to strain.
Very high levels are associated with a poor prognosis
BNP is increased in: LVH ischaemia tachycardia RV overload Hypoxaemia GFR<60 Sepsis COPD Diabetes >70yrs old Liver cirrhosis
What are the drug management options for patients with chronic CCF?
1st line = ACE inhibitor with beta-blocker. Monitor K+
2nd line = aldosterone antagonist. Monitor K+
3rd line:
either
Ivabridine - if SR>75/min and LV fraction <35%
Sacubitril-valsartan - if LV fraction <35%
Digoxin - strongly indicated if patient has AF
Hydralazine with nitrate - if afro-carribean patient
Cardiac resynchronisation therapy - if a widened QRS complex on ECG
What is cor pulmonale?
What signs can a patient present with in cor pulmonale?
Right sided HF due to pulmonary hypertension caused by respiratory disease (commonly COPD)
Signs include: Hypoxia Cynosis Raised JVP Peripheral oedema 3rd heart sounds Murmurs Hepatomegaly - due to back pressure in the hepatic vein
How is cor pulmonale treated?
Loop diuretics for oedema
Oxygen therapy
NICE recommend NOT using ACE inhibitors, calcium channel blockers and alpha-blockers
