Podcast
Questions and Answers
Which of the following is a key pathophysiological process involved in Acute Heart Failure (AHF)?
Which of the following is a key pathophysiological process involved in Acute Heart Failure (AHF)?
- Fluid accumulation in the lungs due to the left ventricle's inability to effectively empty, increasing hydrostatic pressure. (correct)
- Vasodilation causing decreased systemic vascular resistance and increased organ perfusion.
- Increased myocardial contractility, leading to excessive blood flow.
- Increased levels of oxygen in the blood
According to the European Society of Cardiology, all patients with AHF present with both congestion and hypoperfusion.
According to the European Society of Cardiology, all patients with AHF present with both congestion and hypoperfusion.
False (B)
Name one common cause of new-onset Acute Heart Failure (AHF).
Name one common cause of new-onset Acute Heart Failure (AHF).
Acute myocardial dysfunction
Patients with AHF who present with signs of congestion but without signs of hypoperfusion are classified as ______-WARM.
Patients with AHF who present with signs of congestion but without signs of hypoperfusion are classified as ______-WARM.
Match the symptom of acute heart failure with its underlying cause:
Match the symptom of acute heart failure with its underlying cause:
Orthopnea, a common symptom of AHF, is best assessed by asking the patient about:
Orthopnea, a common symptom of AHF, is best assessed by asking the patient about:
Unilateral basal crackles are highly indicative of pulmonary edema due to AHF.
Unilateral basal crackles are highly indicative of pulmonary edema due to AHF.
What bedside investigation is crucial for assessing oxygenation status in a patient with AHF?
What bedside investigation is crucial for assessing oxygenation status in a patient with AHF?
In AHF management, maintaining oxygen saturation within 88-92% is specifically recommended for patients with ______.
In AHF management, maintaining oxygen saturation within 88-92% is specifically recommended for patients with ______.
Match the sign of hypoperfusion with its clinical manifestation:
Match the sign of hypoperfusion with its clinical manifestation:
What condition is represented by the mnemonic CHAMP, which requires early identification in AHF?
What condition is represented by the mnemonic CHAMP, which requires early identification in AHF?
Nitrates are recommended for all 'WET' patients with AHF, regardless of their systolic blood pressure.
Nitrates are recommended for all 'WET' patients with AHF, regardless of their systolic blood pressure.
Name a common loop diuretic used in the management of AHF to alleviate symptoms of congestion.
Name a common loop diuretic used in the management of AHF to alleviate symptoms of congestion.
Following hospital discharge for AHF, patients should ideally have a follow-up appointment scheduled within ______ weeks.
Following hospital discharge for AHF, patients should ideally have a follow-up appointment scheduled within ______ weeks.
Match the medication with its primary mechanism of action in treating AHF:
Match the medication with its primary mechanism of action in treating AHF:
Which of the following is a common arrhythmia that may occur as a complication of AHF?
Which of the following is a common arrhythmia that may occur as a complication of AHF?
Patients with AHF have a decreased risk of thromboembolic events such as stroke.
Patients with AHF have a decreased risk of thromboembolic events such as stroke.
What is the primary goal of oxygen therapy in patients with AHF?
What is the primary goal of oxygen therapy in patients with AHF?
Fine basal ______ are a typical clinical finding indicating pulmonary congestion in AHF.
Fine basal ______ are a typical clinical finding indicating pulmonary congestion in AHF.
Match each clinical finding to whether it indicates pulmonary/systemic congestion or hypoperfusion:
Match each clinical finding to whether it indicates pulmonary/systemic congestion or hypoperfusion:
A patient with AHF presents with dyspnea, orthopnea, and pink frothy sputum. Which of the following is the MOST likely underlying pathology?
A patient with AHF presents with dyspnea, orthopnea, and pink frothy sputum. Which of the following is the MOST likely underlying pathology?
Acute valve dysfunction is a cause of acute decompensation of chronic heart failure (CHF).
Acute valve dysfunction is a cause of acute decompensation of chronic heart failure (CHF).
Other than acute coronary syndrome, name another 'CHAMP' condition that precipitates AHF.
Other than acute coronary syndrome, name another 'CHAMP' condition that precipitates AHF.
The management of AHF patients requires an 'ABCDE' approach, where 'B' stands for ______.
The management of AHF patients requires an 'ABCDE' approach, where 'B' stands for ______.
Associate each NYHA (New York Heart Association) class with its corresponding functional limitation:
Associate each NYHA (New York Heart Association) class with its corresponding functional limitation:
Which of the following is a sign of hypoperfusion in AHF?
Which of the following is a sign of hypoperfusion in AHF?
A gallop rhythm (S3 or S4 heart sounds) is a sign of hypoperfusion in AHF.
A gallop rhythm (S3 or S4 heart sounds) is a sign of hypoperfusion in AHF.
What initial dose of intravenous furosemide is generally administered to a 'WET' patient with AHF?
What initial dose of intravenous furosemide is generally administered to a 'WET' patient with AHF?
Dull ______ at the lung bases can indicate pulmonary congestion due to pleural effusions in AHF.
Dull ______ at the lung bases can indicate pulmonary congestion due to pleural effusions in AHF.
Match the cause of CHF acute decompensation with an example:
Match the cause of CHF acute decompensation with an example:
Flashcards
Acute Heart Failure (AHF)
Acute Heart Failure (AHF)
Acute failure of the heart to pump blood adequately.
Two Main Pathologies in AHF
Two Main Pathologies in AHF
Congestion in pulmonary/systemic circulation and hypoperfusion of vital organs.
Pulmonary Oedema in AHF
Pulmonary Oedema in AHF
Left ventricle fails to empty, increasing pressure in pulmonary vessels, leading to oedema and hypoxia.
Causes of New-Onset AHF
Causes of New-Onset AHF
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Causes of Acute Decompensation of CHF
Causes of Acute Decompensation of CHF
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Typical Symptoms of Acute Heart Failure
Typical Symptoms of Acute Heart Failure
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Signs of Pulmonary/Systemic Congestion
Signs of Pulmonary/Systemic Congestion
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Signs of Hypoperfusion
Signs of Hypoperfusion
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Differential Diagnoses of AHF
Differential Diagnoses of AHF
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Medical Management for AHF
Medical Management for AHF
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Loop Diuretics in AHF management
Loop Diuretics in AHF management
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Complications of AHF
Complications of AHF
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Study Notes
- Acute Heart Failure (AHF) involves the heart's sudden inability to pump enough blood to meet the body's needs.
Pathophysiology of AHF
- Congestion occurs in the pulmonary or systemic circulation.
- Pulmonary edema results from the left ventricle's failure to empty, increasing hydrostatic pressure in pulmonary vasculature, leading to pulmonary edema and hypoxia; these patients are classified as "WET".
- Vital organs experience hypoperfusion due to reduced cardiac output; these patients are classified as "COLD".
- The European Society of Cardiology (ESC) classifies AHF patients into four hemodynamic profiles based on congestion and hypoperfusion:
- 50% show congestion without hypoperfusion ("WET-WARM").
- 45% show congestion with hypoperfusion ("WET-COLD").
- 5% show no signs of congestion ("DRY-WARM" or "DRY-COLD").
Causes of AHF
- New-onset AHF can be caused by:
- Acute myocardial dysfunction (such as ischaemia due to myocardial infarction).
- Acute valve dysfunction.
- Arrhythmias.
- Acute decompensation of Chronic Heart Failure (CHF) can be caused by:
- Infection.
- Acute myocardial dysfunction (such as ischaemia due to myocardial infarction).
- Uncontrolled hypertension.
- Arrhythmias.
- Worsening chronic valve disease.
- Non-adherence with medications or diet.
- Changes in drug regimen.
- Inappropriate withdrawal or reduction of heart failure medications.
- Inappropriate initiation or increase of rate-control medications.
- Other medications like steroids, non-steroidal anti-inflammatories, and pioglitazones.
Clinical Features of AHF
- Typical symptoms include:
- Dyspnoea (shortness of breath).
- Reduced exercise tolerance (classified using the New York Heart Association classification).
- Ankle swelling.
- Fatigue.
- Pink frothy sputum.
- Orthopnoea.
- Paroxysmal nocturnal dyspnoea.
- Other important history areas to cover:
- Chest pain (precipitating cardiac ischaemia or pulmonary embolism).
- Palpitations (precipitating arrhythmia).
- Fever (precipitating infection).
- Medications.
Clinical Examination of AHF
- Cardiorespiratory examination.
- Typical clinical findings include:
- Pulmonary or systemic congestion signs.
- Hypoperfusion signs.
- Signs of pulmonary or systemic congestion:
- Fine basal crackles (bilateral).
- Peripheral oedema (bilateral).
- Dull percussion at the lung bases.
- Raised jugular venous pressure (JVP).
- Hepatomegaly.
- Gallop rhythm (S3 or S4 heart sounds).
- Murmur.
- Signs of hypoperfusion:
- Hypoxia.
- Tachypnoea and accessory muscle use.
- Tachycardia.
- Cyanosis.
- Cold, pale, and sweaty peripheries.
- Oliguria.
- Confusion/agitation.
- Syncope/pre-syncope.
- Narrow pulse pressure.
Differential Diagnoses
- Asthma, COPD, pneumonia, and pulmonary oedema due to AHF can be difficult to differentiate, especially in older patients.
- Myocardial infarction is the leading cause of AHF without established CHF.
- Unilateral basal crackles, especially with cough and fever, are more likely a chest infection.
- A global wheeze suggests asthma, but wheezing can occur in pulmonary oedema.
Investigations of AHF
- Bedside investigations include vital signs:
- Hypoxia (SpO2 < 90%).
- Tachycardia.
- Tachypnoea.
- Systolic blood pressure may be normal, elevated, or reduced.
- Hypotension is associated with cardiogenic shock and poor prognosis.
- Pulse pressure may be narrow.
- Chest X-Ray findings:
- Cardiomegaly.
- Kerley B lines (short horizontal lines near the periphery of the lower lung fields).
- Alveolar oedema (batwing appearance).
- Dilated upper lobe vessels.
- Effusions (pleural effusions – blunted costophrenic angles with meniscus sign).
Management of AHF
- Early senior involvement is important.
- ABCDE approach is essential.
- Investigate and treat the underlying cause of AHF.
- Acute coronary syndrome (ACS).
- Hypertensive crisis.
- Arrhythmias.
- Mechanical problems.
- Pulmonary embolism.
Medical Management of AHF
- Oxygen:
- Titrate to maintain saturations between 94-98% (or 88-92% in those with COPD).
- Avoid hyper-oxygenation.
- Loop diuretics:
- Administer 40mg furosemide intravenously initially.
- Monitor renal function and urine output.
- Nitrates:
- Sublingual glyceryl trinitrate or intravenous nitrates can be used.
- Avoid in those with SBP 75
- Other medications:
- Sacubitril valsartan: for patients who decompensate on an ACEi/ARB.
- Hydralazine and nitrate: for patients who cannot tolerate an ACEi/ARB, or who are on the maximum dose.
- Digoxin: for patients with atrial fibrillation and uncontrolled tachycardia despite a beta-blocker.
- Follow up the patient within 2 weeks of hospital discharge.
Complications of AHF
- Approximately 40% of people admitted to hospital with heart failure die or are readmitted within 1 year.
- AHF may cause arrhythmias, particularly atrial fibrillation.
- There is an increased risk of stroke and other thromboembolic diseases.
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