Heart Failure

Chloe Hymers and Morag Sime

Aim

• Know the difference between left and right heart failure

• Be able to take a history specific to heart failure

• Understand how to investigate heart failure• Know how to manage acute heart failure

Objectives (from your syllabus)

• Recognise left and right heart failure from the history and physical examination and relate them to underlying pathophysiological changes.

• Recognise the role of radiography, ECG and echo in the diagnosis of heart failure

• Initiate management of patients with heart failure by the appropriate use of diuretics, vasodilators and inotropes and monitor the response.

Pathophysiology

• Definition

• Left and right heart failure

• Causes

Causes

• Alcoholic cardiomyopathy

• Infective• Cancer treatment• Coronary heart disease• Hypertension

• Anaemia• Hyperthyroidism• Atrial fibrillation• Congenital• Valvular heart disease

History

• What symptoms?

• How would you ask the patient?

Examination

• What signs may be present?

Investigations

• Bedside tests

• Bloods

• Imaging

• Special tests

CXR findings

• A- alveolar oedema• B- Kerley B lines• C- cardiomegaly• D- diversion to the upper lobes• E- pleural effusion (bilateral)/pulmonary

oedema

A

B

C

D

E

Management- chronic

• Conservative

• Medical

• Surgical

Management- acute

• ABC

• Sit up

• Furosemide

• GTN infusion

Case study

• 61 year old man 3 month history of malaise, SOB and ankle swelling. Short of breath walking up stairs. PMH- hypertension, MI, smoked 40 cigarettes for 40 years.

Questions

• Differential diagnosis

• Heart failure– COPD– Lung cancer– Angina– PE

• Explain cardiac rehabilitation

As an F1…….

• Most important thing is initial management in A and E and flash pulmonary oedema

• AKI vs Pulmonary oedema always a problem

Questions