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COPD-临床表现. 45 (on ABGs) Ventilation- perfusion mismatch High A-a gradient (calculated from ABGs) Low, flat diaphragm, >10 posterior ribs (on frontal CXR) High TLC and VC (on spirometry) • • PaO2: partial pressure of O2 in arterial blood PaCO2: partial pressure of CO2 in arterial blood • In the setting of fever and productive cough ...
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- Right Heart Failure
- 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, 2020Associated Relevant Slides. © 2024 - The Calgary Guide to Understanding Disease Disclaimer
Summary of Acyanotic Congenital Heart Diseases.
Left Heart Failure: Pathogenesis, Symptoms, and Signs (aka Congestive Heart Failure)
May 29, 2024 · Study with Quizlet and memorize flashcards containing terms like The client is admitted to the telemetry unit diagnosed with acute exacerbation of congestive heart failure (CHF). Which signs/symptoms would the nurse expect to find when assessing this client?
People also ask
What questions do people with heart failure ask?
What questions can a caregiver ask a patient about heart failure?
Can CCS be used for acute heart failure?
Apr 19, 2020 · There is no single parameter or test that can diagnose heart failure, rather it is a constellation of signs, symptoms and investigations to make a diagnosis. See CCS algorithm as initial approach to a patient with suspected heart failure.
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related to: calgary guide heart failure test questionsGet Info on a Treatment Option That Lowers LDL-C & Reduce the Risk of Another MI or Stroke. Lower LDL-C and Reduce the Risk of Another MI.
Learn About How Many ASCVD Patients Are At a Very High Risk For A Heart Attack Or Stroke. See Why Testing LDL-C is Essential For ASCVD Patient Risk Evaluation. Visit the Website.
That May Reduce The Risk of Another Heart Attack or Stroke. See More Today.
