acute LV failure

Question 1

acute LVF - presentation on inspection

Answer 1

"this pt would look unwell" - pale + grey
bloodstained + frothy sputum in pot
accessory muscles - orthopnoea
wheeze
cold clammy peripheries - cyanosis

Question 2

acute LVF - signs

Answer 2

sinus tachy / AF
BP can be low, normal, high
raised JVP
cardiomegaly - displaced apex, valve disease signs
HS3/4
pleural effusion

Question 3

acute LVF - initial investigations

Answer 3

GOUGE - DM; hypoxaemia + resp acidosis; arrhythmia, heart block, ischaemia, VH

BNP (raised confirms diagnosis)
troponin (infarct)
echo in 48h - LVEF, valvular disease
CXR

FBC - ?anaemia, ?infection
U+E+C - ?RF, ?derangement. monitor renal function + electrolytes with diuretics

Question 4

acute LVF - causes

Answer 4

CHAMPS
Coronary syndrome
HTive emergency
Arrhythmia
Mechanical eg acute valve leak, VSD, LV aneurysm
PE
Sepsis

Question 5

acute LVF - treatment

Answer 5

call senior + consider early ICU review

A - sit pt up
B - hi flow oxygen 15L/min via nonrebreathe
C - IV vasodilators (GTN/isosorbide infusion) if SBP > 90
D - IV furosemide 40mg
E - ?inotropes eg dobutamine if SBP <90

?ITU w CPAP if no improvement/resp acidosis