Acute Heart failure

• What is heart failure?

  Rapid onset or worsening of the signs and symptoms of heart failure. It is a life-threatening condition in which the heart foes not pump enough blood to meet the body's needs.
• What are the 2 courses of pathology which develop in acute heart failure?

  1. Congestion in the pulmonary and systemic circulation. The left ventricle is unable to empty, increasing hydrostatic pressure in pulmonary vasculature leading to pulmonary oedema and hypoxia.
  2. Hypoperfusion of vital organs as cardiac output is reduced.
• Patients with congestion in the pulmonary and systemic circulation are WET.

  Patients with hypoperfusion of the vital organs are COLD.
• What are the causes of new-onset acute heart failure?

  1. MI
  2. Acute valve dysfunction
  3. Arrhythmias
• What are the causes of acute decompensation of chronic heart failure?

  1. Infection
  2. MI
  3. Uncontrolled hypertension
  4. Arrhythmias
  5. Worsening chronic valve disease
  6. Non-adherance to drug regimen/diet
  7. Change in drug regimen
• What are the symptoms of acute heart failure?

  Dyspnoea

  Reduced exercise tolerance

  Paroxysmal nocturnal dyspnoea

  Pink frothy sputum

  Fatigue

  Orthopnoea

  Ankle swelling
• What are the signs of pulmonary/systemic congestion?

  Fine bilateral basal crackles

  Peripheral oedema

  Dull percussion at lung bases

  Raised JVP

  Hepatomegaly

  Gallop rhythm S3/S4

  Murmur
• What are the signs of hypoperfusion?

  Hypoxia

  Cyanosis

  Tachypnoea

  Accessory muscle use

  Cold pale and sweaty peripheries

  Oliguria

  Confusion/agitation

  Syncope/pre-syncope

  Narrow pulse pressure
• Acute heart failure can be ruled out if BNP is less than 100ng/L or NT-proBNP is less than 300ng/L
• What are the chest x-ray findings in heart failure?

  A - Alveolar oedema

  B - Kerley B lines

  C - Cardiomegaly

  D - Dilated upper lobe vessels

  E - Effusions
• What is the medical management of acute heart failure?

  1. Oxygen
  2. Loop diuretics
  3. Nitrates
  4. NIV
  5. Inotropes and vasopressors
• What is the long term management of acute heart failure?

  1. Diuretics (furosemide)
  2. Beta blockers (bisoprolol)
  3. ACEi/ARBs (ramipril)
  4. Aldosterone antagonist (spironolactone)
  5. Specialist drugs (digoxin, ivabradine)