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CR - Heart failure (ii) (Management (pharmacotx (procorolan (inhibits…

- - - - bibasal creps
      - pleural effusions
      - gallop rhythm with S3
      - displaced/prominent apex
      - murmurs (due to stenosis/regurg)
    - - raised JVP
      - +ve hepatojugular reflex
      - sacral + ankle oedema
      - ascites
  - - - anaemia (increased risk of high CO HF)
      - infection
    - - baseline level NB for drug monitoring (diuretics)
    - - baseline creatinine
      - high transaminases + altered coag indices indicate hep congestion (RHF)
    - - look for ischaemia
      - baseline troponin, then do serials
    - - for screening, dxing + monitoring HF
      - <100: HF unlikely
      - 100-500: use clinical judgement
      - over 500: HF likely
  - - - not responding to Tx
      - suspected CAD (60% of those with HF have)
      - myocardial ischaemia (incl angina)
      - prevalvular surgery
      - assessing SV
  - - - can't accurately comment on size of heart on AP projection
      - if > 1/2 width of thorax
- - - - inhibits funny channel
      - used in combo with BBs or if BBs contraindicated
      - reduces HR without affect BP (unlike BBs, good as many HF already have low BP)
      - used to Tx chronic stable angina in CAD
      - patient must be in sinus rhythm + have HR = 70+ beats/min
    - - NNT=21
      - neprilysin = enzyme that degrades natriuretic peptides
      - can be combined with ARBS (ARNIs)
    - - reduce intravasc vol
      - restore + maintain normal vol status
      - relieve symptoms of fluid overload
        
        congestion (swelling)
        
        elevated filling pressures (e.g. JVP)
  - - - considerations
        
        sinus rhythm
        
        wide QRS
        
        severe left ventricle sys dysfunction (EF<35%, dilation>5.5mm)
        
        persistent symptoms (III/IV) despite optimum medical Tx
    - - arrhythmia prevention
      - when EF < 30/35%
      - not within 40 days of MI
      - for those graded II/III
      - ideally for 3-6 months in combo with biventricular pacemakers
      - for survivors of cardiac arrest with no MI (v fib or v tachy)
      - for patients with no recurrent ischaemic effect > 48hrs post MI
      - not recommended if no reasonable expectation of improvement