LVF and pulmonary oedema Flashcards
(11 cards)
Pathophysiology of Pulmonary oedema
LV cannot move blood though left side of heart
Leads to a back long of blood in the pulmonary arteries
Leakage of fluid from surrounding areas- Lung oedema
The alveoli become full of fluid
This interferes with gas exchange
Triggers
- Iatrogenic e.g. IV fluids to an elderly patient
- Sepsis
- MI
- Arrythmias
Presentation
- Breathlessness- worse lying down
- Cough- frothy sputum
- Increased RR
- Tachycardia
- 3rd heart sound
- Bilateral crackles in the bases
- Low BP- cardiogenic shock– severe
Symptoms associated with aetiology
Chest pain - MIs
Fever- Sepsis
Palpitations - Arrythmias
If also have RVF
Raised JVP
Peripheral oedema
Investigations
ECG - arrhythmias ABG- are they hypoxic or raised CO2 CXR FBC: infections U&E- kidney function BNP- not specific- could also be tachycardia, COPD Troponin ECHO EF; percentage of blood which is squeezed out of LV at each contraction. Normal is above 50%
BNP
Released by cardiac ventricles when stretched due to XS fluid
Positive result is indicative of HF
Normally:
Normal function is to relax the smooth muscle in BV - reduces SVR
BNP acts as a diuretic- reduces circulating fluid
In X-RAY
- Cardiomegaly: cardiothoracic ratio of 0.5
- Upper lobe venous diversion- upper lobe veins in the lungs become filled with blood
- Bilateral fluid effusions
- Fluid in interlobal fissures
- Fluid in septic lines- curly lines
Management
POUR SOD POUR: manage IV fluids S: sit up right O: oxygen- below 95% sats D: Diuretics- loop e.g. furosemide Check body weight
What is EF and what is the normal value for it?
EF; percentage of blood which is squeezed out of LV at each contraction. Normal is above 50%
when in cardiogenic shock
- IV opiates : vasodilators
- NC PAP
- Inotrope: noradrenaline- strengthening the Heart contraction
