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Flashcards in Congestive heart failure Deck (9)
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1

Etiology

Coronary artery disease
Hypertension
Valvular disease
Myocarditis
Infiltrative
Congenital heart disease
Pericardial
Drugs
DM, thyroid, acromegaly
SLE, RA
Chemotherapy
Nutritional
Pregnancy
Familial cardiomyopathy

2

Risk factors

MI
DM
Dyslipidemia
Old age
Male
HTN
Cocaine
Cardiotoxic agents
Renal
VHD
FHx
AFIB
Thyroid

3

Investigations

1. Transthoracic echo
2. ECG->evidence of underlying CAD, LVH, atrial enlargement, conduction
3. CXR
4. BNP
5. FBC->etiologies, exacerbation of HF
6. UEC->hyponatremic
7. Cr/urea
8. Blood glucose
9. LFTs
10. TFTs->hyper/hypothyroidism
11. Blood lipids

4

Management

1. ACEi
2. Sodium restriction + fluid restriction + weight monitoring + continuous health screening + exercise + AHD + Care plan
3. Beta blocker
4. ARB
5. Hydralazine + isosorbide dinitrate
6. Frusemide
7. Digoxin (w/ AFIB)
8. ICD
9. Transplant

5

Patient instructions on discharge

Home weight monitoring
Sodium restriction
Tobacco and alcohol discontinuation
Aggressive control of HTN and diabetes
Lipid management
Regular, symptom limited exercise
Routine health-care maintenance

6

Criteria for diagnosis

Clinical
2 major or 1 major and 2 minor

Major:
NVD
Rales
Acute pulmonary edema
S3 gallop
+venous pressure
Circulation >25 seconds
HJ reflux
Cardiomegaly
PND, or orthopnea

Minor:
Ankle edema
Night cough
Dyspnea on exertion
Hepatomegaly
Pleural effusion
120

Weight Loss >4.5kg in 5 days in response to treatment

7

Management of acute cardiac failure

ABC, IV access, ECG monitoring
Oxygen
Morphine + metoclopramide
Frusemide
Glyceryl trinitrate
Supportive care->maintain oxygen, fluid/salt/weight
Ventilation
Organise echoC
Admit
Regular observations

If hypotensive: ionotrope/vasopressor, omit frusemide and vasodilator, need urinary catheter

Due to:
a. ischemia->aspirin, clopidogrel, revascularisation
b. Valvular->Nitropursside
c. If hypertensive crisis->will need IV beta blockers and GTN +/- nitroprusside

8

Management of acute HF following stabilisation

ACE
Beta blocker
ARB
Vasodilator
Diuretic
Dogoxin
Ivarabine
Supportive care

9

Precipitants of acute CF

Decompensation of pre-existing
Medication non-compliance
HTN crisis
Arrythmia, regurgitation, stenosis, myocarditis, tamponade, dissection, fluid overload, surgery, renal failure, phaeochromC, ++Output->sepsis, anemia, thyrotoxic crisis, anemia, shunt