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Cardiovascular Medicine > Acute Heart Failure > Flashcards

Flashcards in Acute Heart Failure Deck (12):
1

What is acute heart failure?

A medical emergency, with left or right heart failure developing over minutes or hours

2

What additional initial investigations are required in acute heart failure?

1. Serum troponin
- Myocardial necrosis
2. D-dimer
- PE

In addition to the usual CXR, bloods, ECG

3

List the 6 clinical syndromes defined for acute heart failure and describe the features of each

1. Acute decompensation of chronic heart failure
2. Hypertensive heart failure
- High BP
- Preserved LV function
- Pulmonary oedema on CXR
3. Acute pulmonary oedema
- Acutely breathless, tachycardic, sweaty (sympathetic overactivity)
- Wheezes and crackles throughout chest
- Hypoxia
- CXR features
4. Cardiogenic shock
- Hypotension
- Tachycardia
- Oliguria
- Cold extremities
5. High output cardiac failure, e.g. septic shock
- Warm peripheries
- Pulmonary congestion
- BP may be low
6. Right heart failure
- Low CO
- Elevated JVP
- Hepatomegaly
- Hypotension

4

True or false: in acute heart failure, treatment may begin before investigations are completed

True - patients are often too unwell to wait for Ix results

5

True or false: in acute heart failure, patient are managed in HDU

True - require invasive procedures for monitoring and to direct therapy
- Central venous cannulation
- Arterial lines
- Pulmonary artery cannulation

6

True or false: in acute heart failure, all patients require prophylactic anticoagulation

True - e.g. enoxaparin

7

What initial therapy is given to patients with acute heart failure?

1. High flow oxygen
- CPAP may be indicated
2. Diuretics
- Furosemide IV 50 mg
3. Vasodilators
- GTN IV 50 mg in 50 mL saline at 2-10 mL/h
- Only if SBP is > 85 mmHg

8

What therapy can be added in patients with acute heart failure who do not respond to initial therapy?

Inotropic support, e.g. dobutamine

9

A patient comes in with acute heart failure with systolic dysfunction. Following initial therapy her SBP is 110 mmHg. How do you proceed?

Vasodilators
- GTN, nitroprusside, BNP
- e.g. GTN IV 50 mg in 50 mL saline at 2-10 mL/h

10

A patient comes in with acute heart failure with systolic dysfunction. Following initial therapy her SBP is 90 mmHg. How do you proceed?

Vasodilator and or inotrope
- GTN, nitroprusside, BNP
- dobutamine, PDEI

11

A patient comes in with acute heart failure with systolic dysfunction. Following initial therapy her SBP is 75 mmHg. How do you proceed?

1. Volume load?
2. Inotrope / dopamine / noradrenaline

12

A patient comes in with acute heart failure with systolic dysfunction. Following initial therapy her SBP is 85 mmHg so a vasodilator and inotrope are given. However there is no response. How do you proceed?

Consider mechanical assist device, e.g. right or left or bi-ventricular assist devices.

If good response, continue long-term oral therapy: furosemide, ACEI