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Management of heart failure - Coggle Diagram
Management of heart failure
Heart failure = abnormalities of cardiac systolic or diastolic function, or both.
Can occur without evidence of abnormal fluid accumulation (congestion), esp. in initial stages of disease
characterised by high cardiac filling pressure
leads to venous congestion and tissue fluid accumulation
Common causes
myocardial failure
idiopathic dilated cardiomyopathy
either L or R CHF
Myocardial ischaemia/infarction
L CHF
Drug toxicities e.g. doxorubicin
L CHF
infective myocarditis
either L or R CHF
Volume flow overload
mitral valve regurgitation (degenerative, congenital, infective)
LCHF
aortic regurgitation (infective endocarditis, congenital)
LCHF
ventricular septal defect
LCHF
Patent ductus arteriosus
LCHF
Tricuspid valve regurgitation (degenerative, congenital, infective)
RCHF
Tricuspid endocarditis
RCHF
Chronic anaemia
either L or RCHF
Thyrotoxicosis
either L or RCHF
Pressure overload
(sub)aortic stenosis
LCHF
systemic hypertension
LCHF (rare)
pulmonic stenosis
RCHF
heart worm disease
RCHF
pulmonary hypertension
RCHF
Impaired ventricular filling
hypertrophic cardiomyopathy
L / R CHF
Restrictive cardiomyopathy
L/R CHF
Cardiac tamponade
RCHF
Constrictive pericardial disease
RCHF
LCHF - main congestive sign is pulmonary oedema
RCHF - main congestive sign is ascites +/- pleural effusion
Acute
Minimise stress and excitement
avoid excessive heat
cage rest
Improve oxygenation
ensure airway patency
give supplemental o2
postural support (sternal, head elevation)
if frothing evident, suction airways
intubate and mechanically ventilate if necessary
thoracocentesis (if pleural effusion evident or suspected)
Diuresis
Furosemide
IV: effects within 5 mins, peak 30 mins and lasts about 2 hours
this route also provides mild vasodilating effect
provide access to water after diuresis begins
support cardiac pump function (inodilator)
pimobendan
increases contractility while also causing systemic and pulmonary vasodilation
Reduce anxiety
butorphanol
morphine
acepromazine
diazepam
Redistribute blood volume
vasodilators
sodium nitroprusside if able to monitor BP closely
morphine (dogs only)
phlebotomy
6-10ml/kg
Further after load reduction
esp. for mitral regurgitation
hydralazine
enalapril
amlodipine
Additional inotropic support (if myocardial failure or persistent hypertension present)
dobutamine
amrinone
digoxin
Minimise bronchoconstriction
aminophylline
Monitor and address abnormalities
respiratory rate
heart rate and rhythm
arterial pressure
o2 saturation
body weight
urine output
hydration
attitude
serum biochemistry
blood gas analyses
pulmonary capillary wedge pressure