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Heart Failure

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. A clear and concise understanding of what heart failure is

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Heart Failure

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  1. Heart Failure James Masters

  2. Rough outline • Introductionoverview • Allocation of teams • 5 minutes for signs and symptoms • 5 minutes for investigations and management • Imaging • Questions

  3. Learning Objectives • A clear and concise understanding of what heart failure is • Appreciate the clinical features of acute and chronic heart failure • Be able to provide the most common causes of heart failure

  4. Global Definition • Any volunteers?

  5. 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

  6. Different flavours Heart Failure Left and right Preload and afterload High output low output Systolic and diastolic

  7. Symptoms • Respiratory • Cardiac • Other

  8. Examination Findings Left heart failure Right heart failure Tachypnoeic Raised JVP Pulsatilehepatomegaly Peripheral oedema • Tachypnoeic • Weak radial pulse • Cyanosis • Displaced Apex • Additional heart sounds • May be signs of underlying cause

  9. Clinical Scenario • Please take history

  10. Clinical Scenario • Please examine patient

  11. 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.

  12. Differential Diagnosis

  13. Differential Diagnosis Important Heart failure COPD Malignancy

  14. Investigations • UBEXS? • Urine • Bloods • ECG • X-ray • Special tests

  15. Investigations • Urine • Bloods • FBC, U&E, LFTs, Bone, BNP • ECG-clues • X-ray-See later • Special tests-Mulitple! Echocardiogram

  16. Management • Conservative • Medical • Surgical

  17. Conservative • Smoking cessation • Alcohol • Diet • Weight loss • Cardiac rehabilitation

  18. Management Acute Chronic Complex Briefly Beta blocker ACEi Diuretic Cause • 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

  19. Some examples

  20. RIGHT SIDED PNEUMOTHORAX LEFT UPPER LOBE CONSOLIDATION

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