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Transcript of Heart Failure James Masters. Rough outline Introduction overview Allocation of teams 5 minutes for...
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Heart Failure
James Masters
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Rough outline
• Introduction overview• Allocation of teams• 5 minutes for signs and symptoms• 5 minutes for investigations and management• Imaging• Questions
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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
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Global Definition
• Any volunteers?
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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
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Different flavours
Heart Failure
Left and right
Systolic and diastolic
High output low outputPreload and afterload
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Symptoms
• Respiratory• Cardiac• Other
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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
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Clinical Scenario
• Please take history
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Clinical Scenario
• Please examine patient
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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.
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Differential Diagnosis
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Differential Diagnosis
ImportantHeart failureCOPDMalignancy
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Investigations
• UBEXS?• Urine• Bloods• ECG• X-ray• Special tests
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Investigations
• Urine• Bloods– FBC, U&E, LFTs, Bone, BNP
• ECG-clues• X-ray-See later• Special tests-Mulitple! Echocardiogram
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Management
• Conservative • Medical • Surgical
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Conservative
• Smoking cessation• Alcohol• Diet• Weight loss• Cardiac rehabilitation
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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
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Some examples
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RIGHT SIDEDPNEUMOTHORAX
LEFT UPPER LOBECONSOLIDATION
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