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 output Preload 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

Important Heart failure COPD Malignancy

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 mg SL GTN 1-2 tabs ± IV GTN infusion mcg/min (start high) PO/IV FUROSEMIDE 40 mg od (80 mg if creat ; 120 mg if ; 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 SIDED PNEUMOTHORAX LEFT UPPER LOBE CONSOLIDATION