Congestive Heart Failure
Summary
Clinical Features
--END OF SUMMARY--
Clinical Features
- HI JVP, lung basal crackles, S3
--END OF SUMMARY--
Definition
Impaired filling or ejection of either ventricle
Aetiology
Top 5
H TN
E nvironment (heat)
A rrhythmia
R heumatic heart disease/ valvular
T hyrotoxicosis
F ailure to take meds
A naemia
I schaemia/ infarct/ infection
L ung (PE, pneumonia, COPD)
E ndocrine (pheo, hyperaldosteronism)
D iet
Clinical Features
Impaired filling or ejection of either ventricle
Aetiology
Top 5
- CAD
- HTN
- Idiopathic (often dilated cardiomyopathy)
- Valvular (eg AS, AR, MR)
- Alcohol (dilated cardiomyopathy)
H TN
E nvironment (heat)
A rrhythmia
R heumatic heart disease/ valvular
T hyrotoxicosis
F ailure to take meds
A naemia
I schaemia/ infarct/ infection
L ung (PE, pneumonia, COPD)
E ndocrine (pheo, hyperaldosteronism)
D iet
Clinical Features
Investigations
Bedside: ECG (enlargement, arrhythmia, STdep/ ele)
Bloods: FBC, UEC, BSL, TFT, lipids, LFT, Fe studies, BNP
Imaging: CXR (cardiomegaly, effusion, PO), Echo (pericardial effusion, valves, walls)
NOTE: CXR signs of HF = HERB-B (Heart enlargement - >0.5ratio, pleural effusion, re-distribution (PO), Kerley B lines, bronchiolar-alveolar cuffing)
Management
Pulmonary Oedema
Treat the cause
L oop diuretics (Frusemide)
M orphine
N itroglycerin
O xygen
P ositive airway pressure
P osture (sit up, legs hang down)
Secondary prevention
Lifestyle (SNAP)
* Mortality benefit
Source
Toronto Notes 2012
Bedside: ECG (enlargement, arrhythmia, STdep/ ele)
Bloods: FBC, UEC, BSL, TFT, lipids, LFT, Fe studies, BNP
Imaging: CXR (cardiomegaly, effusion, PO), Echo (pericardial effusion, valves, walls)
NOTE: CXR signs of HF = HERB-B (Heart enlargement - >0.5ratio, pleural effusion, re-distribution (PO), Kerley B lines, bronchiolar-alveolar cuffing)
Management
Pulmonary Oedema
Treat the cause
L oop diuretics (Frusemide)
M orphine
N itroglycerin
O xygen
P ositive airway pressure
P osture (sit up, legs hang down)
Secondary prevention
Lifestyle (SNAP)
- ACEI/ ARB *
- Beta blockers *
- Aldosterone antagonist (spironolactone) *
- Diuretics
- Inotopes (digoxin)
- Antiarrhythmic (b-blocker, amiodarone, digoxin)
- Anticoagulant
* Mortality benefit
Source
Toronto Notes 2012