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heart failure | Calgary Guide. SEARCH RESULTS FOR: heart failure. Left Heart Failure - Pathogenesis. Right Heart Failure. Left Heart Failure - Physical Exam Findings. Left Heart Failure - Findings on History. Left Heart Failure: Pathophysiology (Neurohormonal Activation) Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Pathogenesis.
Left Heart Failure: Pathogenesis. Left Heart Failure: Pathogenesis. Post Views: 54,332. Associated Relevant Slides. ... The Calgary Guide to Understanding Disease
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Can CCS be used for acute heart failure?
Can CCS be used for acute heart failure?
SEARCH RESULTS FOR: Congestive heart failure Left Heart Failure: Pathophysiology (Neurohormonal Activation) Hyperkalemia- Physiology Torsades de Pointes (TdP)- Pathogenesis and Clinical Findings Summary of Acyanotic Congenital Heart Diseases chronic-hypertension-complications Coronary Artery Bypass Graft CABG Indications
Associated Relevant Slides. © 2024 - The Calgary Guide to Understanding Disease Disclaimer
- Introduction
- Diagnosis
- Treatment
- Monitoring and Discharge
- Further Reading
- Authors
Acute Heart Failure (AHF) is worsening or decompensation of the signs and symptoms of heart failureInitial evaluation should focus on confirming diagnosis and precipitating causesTreatment includes supportive measures (i.e. oxygenation and blood pressure), loop diuretics for volume overload, and escalating advanced therapies if requiredOnce out of the acute phase, guideline-directed medical therapy should be initiated (discussed in the Chronic Heart Failure topic)Symptoms
1. Progressive shortness of breath (LR+ 1.3) 2. Orthopnea (LR+ 2.2) 3. Paroxysmal Noctural Dsypnea (LR+ 2.6) 4. Ankle swelling 5. Abdominal fullness 6. Weight gain (LR+ 1.0) 7. Nausea and/or anorexia (hepatic congestion) 8. Fatigue/lethargy (LR+ 1.0)
Signs
1. Elevated JVP (LR+ 5.1) 2. Positive hepatojugular reflux (10s pressure, 3cm rise) (LR+ 6.4) 3. Crackles (LR+ 2.8) 4. Decreased air entry to bases (pleural effusion) 5. S3 (LR+ 11) 6. Laterally displaced apex beat Note: JAMA – “Does This Dyspneic Patient in the Emergency Department Have Congestive Heart Failure?” Full article here
Search for a Precipitant
1. If trigger not identified, patient may have refractory HF or recurrent admissions
Supportive Care
1. Supplemental oxygen 1.1. Indicated for patients who are hypoxemic, target oxygen saturation above 90% 1.2. Potential harm of oxygen on normoxic patients in physiologic studies 2. CPAP/BIPAP: 2.1. Indications: 2.1.1. High respiratory rate (concern for fatigue) 2.1.2. Persistent hypoxemia despite high flow oxygen 2.2. Note: Noninvasive ventilation is not recommended for routine use in acute heart failure (3CPO Trial) 1. Diet: 2. 2.1. Cardiac diet with salt (<2g/day) and fluid (<2L/day) restr...
Diuretic Therapy
1. IV Diuretics: 1.1. First line therapy for patients with volume overload (pulmonary or peripheral) 1.2. IV intermittent dosing recommended over IV continuous as no proven benefit of IV continuous but limits patient mobility 1.3. IV high dose (oral dose = IV dose x 2.5, ie. 40 mg PO = 100 mg IV) or low dose (oral dose = IV dose, ie. 40 mg PO = 40 mg IV) are reasonable options with high dose shown to have faster symptom resolution without a significant difference in renal function (DOSE trial)
Other Medical Therapy
1. IV Vasodilators: 1.1. Indication: Relief of dyspnea in hemodynamically stable patients (SBP >100 mmHg) 1.2. Options: Nitroglycerin, nesiritide, or nitroprusside; and if not available, nitro patch or oral ISDN can be used 1.3. Note: No evidence for reduction of hospitalization or mortality thus should be used for symptom control 2. IV Inotropes: 2.1. Not recommended for routine use for hemodynamically stable patients (i.e. milrinone, dobutamine, dopamine, or levosimendan). 2.2. May be used...
Monitoring and Targets
1. Monitor patient fluid intake/output and weight 2. Target net in/ outs of -1L and weight loss of 1kg 3. If not achieving target, increase diuretic dose by 50% 4. Practical Tip: If not achieving target at high dose IV lasix (160-240 mg total per day), consider adding metolazone, changing to IV continuous dosing and/or adding inotropic support in conjunction with Nephrology or Cardiology consultation
Discharge
1. Once euvolemic, transition to lowest dose of oral diuretic to maintain euvolemia 2. Monitor patient for 24 hours after transition from IV to oral diuretic 3. Note: Oral furosemide has 50% bioavailability of IV furosemide (Ie. 40mg IV approximates 80mg PO) 4. Patients should be started on guideline-directed medical therapy before discharge (i.e. Beta blocker, ACE/ARB/ARNI, MRA) 4.1. See pending Chronic Heart Failure topic for more information
2017 CCS: Management of Heart Failure (html) (pdf) (pocketcard)2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure (html) (pdf)2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (html)Primary Author: Dr. Atul Jaidka(MD, FRCPC, Cardiology Fellow)Staff Reviewer: Dr. Robert McKelvie (MD, FRCPC[Cardiology])Copy Editor: Perri Deacon (medical student)Last Updated: March 28, 2020Left Heart Failure: Pathogenesis, Symptoms, and Signs (aka Congestive Heart Failure)
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related to: calgary guide heart failureGet Info on a Treatment Option That Lowers LDL-C & Reduce the Risk of Another MI or Stroke. View Support & Resources for Your ASCVD Patients With High LDL-C.
Schedule an Appointment Today With Cleveland Clinic, a Leader in Heart Failure Treatment. Cleveland Clinic Offers the Latest Advanced Heart Failure Treatment Options. Learn More.
Visit The Official Site And See If You Qualify To Save On A Once-Daily Treatment Option. Visit The Official Site To Learn More About Using A Once-Daily Treatment Option.
