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CR - Heart failure (iii) (Complex patients (severe persistent symptoms,…
CR - Heart failure (iii)
complications
impaired exercise tolerance
A fib
SCD (v tachy/fib)
renal insufficiency
thromboembolic disease (as patients often immobilised)
decompensated HF
cardiogenic shock
50% of this admitted with decompensated HF are readmitted in 6 months
Some drugs make CHF worse
CCBs increase LL oedema
longterm NSAIDs/COx inhibitors
all antiarrhythmics are proarrhythmic (prolong QT interval)
Doxazosin (antihypertensive)
OTC cold sores (pseudoephedrine)
thiazolidinediones (reduce insulin resistance)
anti-TNF drugs (e.g. in RA)
chemo
herceptin (do baseline + serial ECHOs)
doxorubicin
cyclophosphamide (cardiotoxic)
acute management
sit patient up
give 60-100% O2 (careful in COPD)
Tx unstable angina
IV morphine 2.5-5mg
vasodilatory
stops SOB
pain relief
furosemide 10-120mg injection
diuretic
txs oedema + hypertension
repeat if required
investigate
insert urinary catheter to measure urine output (assess response to diuretics)
if not responding transfer to ICU
CPAP (single pressure)
BiPAP
intubation
Complex patients
severe persistent symptoms
renal dysfunction
hypotension
severe hypertension
metabolic derrangements
SEs/intolerant to standard Tx
preserved EF
VAD
transplant