Heart Failure Pulmonary Edema Flashcards
List 8 precipitants of heart failure
Non compliance
Infection and ischemia
Arrhythmias
High CO states such as thyrotoxicosis, anemia and pregnancy
Renal failure
Drugs such as steroids and NSAIDs
High salt intake
Valvular pathology
Outline the new York heart association classes of heart failure/dyspnoea
1: no limitations of ordinary activity
2. Slight limitation of ordinary activity
3. Marked limitation of physical activity
3b: Comfortable at rest and symptomatic with minimal activity
4: symptoms occur at rest
Killip classification of heat failure in Acute MI to assess the severity of HF.
Killip I: no clinical signs of heart failure,
Killip II: crackles in the lungs, third heart sound (S3), and elevated jugular venous pressure
Killip III: acute pulmonary oedema
Killip IV: cardiogenic shock or arterial hypotension (measured as systolic blood pressure < 90 mmHg), and evidence of peripheral vasoconstriction (oliguria, cyanosis, and diaphoresis)
Name three circumstances where CXR does not reveal heart failure typical features.
No longstanding HF- Normal size heart
Longstanding CCF -lymphatics
COPD – minimal findings
What are the differential diagnoses of acute Cardiogenic pulmonary oedema?
Neurogenic pulmonary oedema
Pulmonary embolism
Pulmonary fibrosis
Pneumothorax
What is the initial treatment of acute heart failure?
Oxygen is sats<95
Furosemide
Isosorbide dinitrates
ACE inhibitors may be added FOR RAPID REDUCTION of afterload and preload.
What is the main goal of acute pulmonary edema treatment?
To redistribute fluid out of the lung
Name drugs commonly used for ionotropic support of someone with hypotension.
Dobutamine, milrinone, dopamine and adrenaline
Only used if LV function is poor and the patient is hypotensive or shocked
When should intubation be considered in management of acute pulmonary edema?(4)
Cardiac arrest
Imminent respiratory failure
No improvement on NPPV
Patient not tolerating NPPV
When should NIPPV be considered in acute management of pulmonary oedema?
If respiratory failure or acidosis occurs.
Note: CPAP decreases work of breathing, improves oxygenation, CO2 exchange
Outline how CPAP should be delivered in heart failure.
Start with a low PEEP of 5, and slowly increase as needed.
Note: Educate patient how to hold mask and breathe, as it is uncomfortable
Who should be referred to the medicine department?
Patients requiring ongoing monitoring and in-hospital treatment will need referral to Internal medicine
Outline the discharge criteria after acute management of heart failure.(6)
No longer hypoxic on room air
Vital signs have returned to normal parameters
Return to baseline effort tolerance
Cause of failure identified and appropriately managed
Patient understanding of medication compliance checked
Medication adjusted as required
Follow up arranged
Outline the treatment of acute pulmonary edema
Stabilise ABCs
Drug management
1. Nitrates
2. ACE inhibitors calpatril
3. Diuretics
If respiratory distress or acidosis: Non invasive positive pressure ventilation
