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Cardiology: Heart Failure - Coggle Diagram
Cardiology: Heart Failure
Classified based on EF
preserved EF 50+%
mid-range EF 40-49%
reduced EF <40%
Causes
Ischaemia
Toxin damage
Infiltrative diseases (amyloid, sarcoid, haemochromatosis)
Genetic conditions
HTN
fluid overload (renal failure or iatrogenic)
arrhythmias
NYHA classes
I: no limitations
II: no sx @ rest, mild sx with activity
III: no sx @ rest, marked sx with activity
IV: sx @ rest
Signs + Sx
Oedema + weight gain
productive cough (pink frothy sputum)
SOB (esp orthopnoea + PND)
chest discomfort
S3 + gallop rhythm
elevated JVP
Parasternal heave
Tx
Optimise CV risk factors
Acute decompensation
IV loop diuretics (furosemide 40-60mg)
O2, consider CPAP
If severe consider intra-aortic balloon pump / LVAD
sit up
insert urinary catheter
consider GTN infusion
consider ICU for inotropes if severely hypotensive
ACEi + B-blockers
ICD recommended in
those with severely reduced EF (≤30%)
Angiotensin
neprilysin inhibitors (ARNIs)
NB NOT to be used with ACEis and B-blockers
Sacubitril/valsartan
diuretics
CRT
resynchronises left ventricle, creating more coordinated systolic movement + increasing EF
LVAD or transplant in NYHA Stage IV who are failing medical tx + have recurrent admissions requiring inotropes
LVAD often bridge to transplant
CXR findings
alveolar oedema (bat wing opacities)
kerley b lines
cardiomegaly
diversion of upper lobe vessels
pleural effusion