Treatment of Heart Failure

Question 1

How are patients with HF scored?

Answer 1

Various systems exist most taking into account:

• BP
• Heart Rate
• left ventricular ejection fraction
• serum sodium
• peak Voxygen
• Cause of HF
• Width of QRS

Question 2

What are the indications for heart transplant?

Answer 2

Severe symptoms even with optimal medical management
Assistive device implanted
Poor prognosis with progressive symptoms

Question 3

How can you classify acute decompensated HF?

Answer 3

Considering tissue perfusion (whether they are warm or cold) and pulmonary congestion (whether they are wet or dry)

Question 4

What is the treatment protocol for acute HF

Answer 4

Oxygen (stats >95%)
Morphine and antiemetic
Nitrates (peripheral vasodilator) and frusemide (diuretic)
If not improving consider CPAP or intubation and ventilation
Can use IABP in patients with stable disease

Question 5

What is an IABP?

Answer 5

An Intra-aortic balloon pump, it is inserted into the descending aorta and constricts and inflates out of time with the heart to assist with emptying the left ventricle

Question 6

Advantages of CPAP in patients with severe pulmonary oedema

Answer 6

Reduced need for intubation

Reduced Mortality

Question 7

Advantages of Ventilation in patients with severe pulmonary oedema

Answer 7

Increases alveolar pressure reduces oedema formation
Ensures oxygenation
Increases Mean arterial pressure (MAP)
Removes the work of breathing reducing total oxygen demand

Question 8

Disadvantages of Ventilation in patients with severe pulmonary oedema

Answer 8

Sedation reduces sympathetic drive
Immobility
Increased infection risk
Risk of Systemic inflammatory response syndrome (SIRS)

Question 9

Why should you be careful giving diuretics to patients with hypertensive HF?

Answer 9

These patients may be both fluid overloaded and intravascularly deplete so diuretics cause inadequate perfusion leading to MI

Question 10

What is Cardiogenic Shock

Answer 10

Failure of oxygen delivery to the organs

Question 11

What is the mortality from cardiogenic shock?

Answer 11

50% and 70% require admission to ICU

Question 12

How is Cardiogenic shock treated?

Answer 12

• Look for cause (hypovolaemia, etc)
• Give Oxygen
  Inotropes (Dobutamine, Dopamine, Adrenaline) are used to drive the heart,sacrificing myocytes to maintain organ perfusion
• Vasopressors are used to ensure cerebral perfusion

Question 13

Treatment of heart failure

Answer 13

Manage comorbidities
Offer ACE I and b blockers
Seek specialist advice
Consider hydralazine w/nitrates