decompensating heart failure - sth decompensated heart failure.pdf · acute decompensated heart...
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B Y K E R R Y M O R T O N
DECOMPENSATING HEART FAILURE
DEFINITION
“The new onset or recurrence of symptoms and signs of heart failure requiring urgent or emergency treatment and resulting in seeking unscheduled hospital care.”
Many patients may have a gradual worsening of symptoms that reach a level of severity necessitating urgent care.
SYMPTOMS
Breathlessness
Worsening chronic heart failure Fluid overload, chest congestion, pulmonary oedema, pleural
effusions Chest infection Rhythm abnormalities Anaemia Pulmonary Embolus Anxiety Cancer Lung disease
Asthma COPD Bronchiectasis Emphysema
Ascites
Ascites
Abdominal discomfort
Liver congestion
Nausea
Feeling full/bloated
Increased breathlessness
Decreased mobility
Other symptoms
Dizziness
Weight gain
Reduced mobility
Palpitations
Chest pain
Arrhythmias
Lethargy/insomnia
Cognitive impairment Forgetfulness
Poor understanding
Monitoring
Daily weights – response to loop diuretic
Fluid intake – restrict to 1.5 litre per day
Renal function – U&Es
Cognitive impairment Concordance
Understanding of condition
Liver function - LFTs
Blood pressure
Heart rate – ECG
Response to medication changes and diuretics
Treatment
Oral or IV loop diuretics Bumetanide or furosemide
IV furosemide
Medications Rate control
BP control
A reduction in medications affecting the kidneys
Other diuretics Thiazide or thiazide like medications
Mineralocorticoid Receptor Antagonists – MRAs – Spironolactone and Eplerenone
Where do we treat
At home – oral diuretics
HFSN
GP
Hospital admission
Ward
CCU/ITU
AID-HF (Ambulatory Intravenous Diuretic for Heart Failure)
HFSN
Consultant Cardiologist
Cardiogenic Shock
Hypotension
Organ hypoperfusion despite adequate fluid resuscitation
Poor perfusion to peripheries
Cold and clammy
End organ dysfunction; renal, hepatic and central nervous system is common
Poor perfusion to peripheries
Deteriorating Patient
Respiratory support CPAP or BIPAP
Renal Support/Management of fluid overload IV furosemide
CVVH
CVVHDF
Dialysis
Cardiac support Inotropes (Noradrenaline/Dobutamine)
Phosphodiesterase inhibitors (Milrinone)
Monitored level 2/3 bed
GTN infusion – ward level
Conclusion
Patients with chronic heart failure can gradually or acutely deteriorate resulting in a hospital admission
Early intervention may prevent this progression
Education, monitoring and changes in treatment will assist in preventing such admissions