LVF Secondary Survey

Question 1

LVF - HPC

Answer 1

fatigue, 
dyspnoea, 
congestion, 
persistent cough, 
no trauma?, 
SOCRATES

Question 2

LVF - RMH

Answer 2

coronary artery disease
heart failure
hypertension, 
oedema, 
Atrial fibrillation, 
arrhythmias, 
tachycardia, 
valvular disease, 
congenital heart disease, pacemaker, 
MI!!!

Question 3

LVF - Pt meds

Answer 3

diuretics ,
beta blockers (e.g. Bisoprolol) , ace inhibitors (e.g. Ramipril), digoxin,
ALLERGIES

Question 4

LVF - Inspection

Answer 4

• Oedema
• Dyspnoea
• Frothy sputum (white or pink)
• Cyanosis
• Clubbing
• Peripheral oedema (may be a sign of LVF becoming more global?)

If non-acute I would continue with secondary examination:

Question 5

If non-acute I would continue with secondary examination: Incl.

Answer 5

Palpate

• Diaphragmatic excursion
• Respiratory excursion
• Trauma, pain
• Help with differential diagnosis

Percuss
- ? dullness (hypo-resonance) due to congestion especially in base of lungs

Auscultate

• Crackles, especially in base of lungs
• ?Transmitted voice sounds
• 3rd heart sound = v specific for heart failure (99%) but not very sensitive (24%)

Question 6

LVF - ECG may show:

Answer 6

May show signs of LV hypertrophy (look up)

If shows signs of heart failure due to ACS then needs to be managed as ACS

Question 7

LVF - Signs of inadequate perfusion:

Answer 7

• Reduced LOC

- CRT

Question 8

LVF - Signs of adequate perfusion

Answer 8

• NO ALOC
• > 90SBP
• No Pallor
• CRT

Question 9

LVF - Signs of congestion

Answer 9

• Pulmonary oedema
• Peripheral oedema
• > JVP

Question 10

LVF Managemnt (Warm-Dry)

Answer 10

Perfused (warm) Uncongested (dry)

• Reassurance
  1. O2 is SpO2

Question 11

LVF Management (Warm - Wet)

Answer 11

Perfused (warm) congested (wet)

• If major ABC, correct ABC and undertake transfer to nearest hospital
• Reassurance
  1. Sit up right if possible
  2. O2 is SpO2 90SBP
  4. Furosemide if congested after GTN (lack of evidence for efficacy)
  5. Consider salbutamol if wheeze present (unclear evidence for efficacy/harm)

Question 12

LVF Management (Cold - Dry)

Answer 12

Poor perfusion (cold) uncongested (dry)

• If major ABC, correct ABC and undertake transfer to nearest hospital
• Reassurance
  1. O2 is SpO2

Question 13

LVF Management (Cold - Wet)

Answer 13

Poor perfusion (cold) congested (wet)

• If major ABC, correct ABC and undertake transfer to nearest hospital
• Reassurance
  1. Sit up-right, but consider perfusion level so do gently
  2. O2 is SpO2