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Mostly caused by IHD, cardiomyopathy, HTN. Other causes include valvular heart disease, pericardial
disease, congenital, arrhythmias, ETOH/drugs.
Acute heart failure is cardiogenic dyspnea with pulmonary congestion. Aka Acute Pulmonary Edema.
Often caused by extensive MI ± rupture, acute valvular regurgitation (eg. Mitral papillary/chordal
rupture or aortic valve endocarditis), PE, and tamponade.
Acute:
General PC: Fatigue, exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, anorexia,
nausea.
Symptoms:
- LVF o Muscle wasting
o Dyspnoea - RVF
o Poor exercise tolerance o Peripheral oedema
o Fatigue o Abdominal distension
o Orthopnoea o Nausea
o Paroxysmal nocturnal dyspnoea o Anorexia
o Nocturnal cough (pink frothy sputum) o Facial engorgement
o Wheeze o Pulsation in neck and face
o Nocturia o Epistaxis
o Cold peripheries
o Weight loss
Signs
- LVF
o General inspection
Tachypnoea (due to raised pulmonary pressures)
Central cyanosis (due to pulmonary oedema)
Cheyne-stokes breathing (oscillation between apnoea and tachypnoea)
Peripheral cyanosis (low cardiac output)
Hypotension
Cachexia
o Pulse Sinus tachycardia
o Apex beat displaced with dilatation of the LV
o Auscultation LV S3, functional mitral regurgitation
o Lung fields crackles from pulmonary oedema
- RVF
o General signs
Ankle/abdominal swelling
Peripheral cyanosis
o Pulse – low volume
o JVP – elevated, Kussmaul’s sign (JVP that rises with inspiration)
o Apex beat – right ventricular heave
o Auscultation – right ventricular S3, pansystolic murmur of tricuspid regurg
o Abdo – tender hepatomegaly
o Oedema – pitting ankle and sacral oedema, ascites or pleural effusions
Ex: Cardiomegaly with mitral regurgitation, gallop rhythm, crackles at lung bases, JVP, hepatic
enlargement, dependant pitting edema, ascites, pleural transudates.
Ix: FBC, LFT, U&Es, cTn, CK, TFT, CXR (ABCDE alveolar or interstitial shadowing , Kerley B lines,
peribronchial cuffing/cardiomegaly, prominent upper lobe veins and diversion, bat’s wing
shadowing, fluid in fissures, pleural effusion,), ECG, BNP/NTproBNP, *echocardiogram*, stress
echocardiography, radionuclide angiography (RNA), single photon emission computed tomography
(SPECT) cardiac MRI, PET, cardiac catheterization, cardiac biopsy, Holter monitor, VO 2 testing.
Tx: Supportive. Relieve Sx, prevent and control disease progression, improve QoL. Risk factor
reduction (Risk Factors: SHIFT MAID smoking, HTN, noninsulin DM, family Hx, triglycerides, male,
age, inactivity, diet), education. Treat causes: dysrhythmias, valvular heart disease etc.