Heart Failure

James Masters

Rough outline

• Introduction overview• Allocation of teams• 5 minutes for signs and symptoms• 5 minutes for investigations and management• Imaging• Questions

Learning Objectives

1. A clear and concise understanding of what heart failure is

2. Appreciate the clinical features of acute and chronic heart failure

3. Be able to provide the most common causes of heart failure

Global Definition

• Any volunteers?

A definition

• Heart failure is a clinical syndrome characterized by systemic perfusion inadequate to meet the body's metabolic demands as a result of impaired cardiac pump function

Different flavours

Heart Failure

Left and right

Systolic and diastolic

High output low outputPreload and afterload

Symptoms

• Respiratory• Cardiac• Other

Examination Findings

Left heart failure• Tachypnoeic• Weak radial pulse• Cyanosis• Displaced Apex• Additional heart sounds• May be signs of underlying

cause

Right heart failure• Tachypnoeic• Raised JVP• Pulsatile hepatomegaly• Peripheral oedema

Clinical Scenario

• Please take history

Clinical Scenario

• Please examine patient

Clinical Scenario

• A 61 year old gentleman presents to the GP surgery with a 3 month history of general malaise, increasing SOB and ankle swelling. He now gets SOB walking up stairs. He has a past medical history of hypertension, previous MI in 2008 and he has smoked 40 cigarettes a day for the past 40 years.

Differential Diagnosis

Differential Diagnosis

ImportantHeart failureCOPDMalignancy

Investigations

• UBEXS?• Urine• Bloods• ECG• X-ray• Special tests

Investigations

• Urine• Bloods– FBC, U&E, LFTs, Bone, BNP

• ECG-clues• X-ray-See later• Special tests-Mulitple! Echocardiogram

Management

• Conservative • Medical • Surgical

Conservative

• Smoking cessation• Alcohol• Diet• Weight loss• Cardiac rehabilitation

Management

Acute• Sit up• OYXGEN (high flow)• IV MORPHINE 2.5-5.0 mg• SL GTN 1-2 tabs ± IV GTN infusion 10-

200 mcg/min (start high)• PO/IV FUROSEMIDE 40 mg od (80 mg

if creat 120-200; 120 mg if 200-400; 250 mg, if 400+)

• ± ?ACS protocol, if ?MI - ie Rx STEMI appropriately (PCI? Thrombolysis?) ± Rx of ?arrythmia ± Rx endocarditis

Chronic• Complex• Briefly

– Beta blocker– ACEi– Diuretic– Cause

Some examples

RIGHT SIDEDPNEUMOTHORAX

LEFT UPPER LOBECONSOLIDATION