Table of Contents
Include in assessment
- ECG – the acute LVF may be caused by ACS or an arrhythmia
- CXR
- Echocardiogram
- Catheterise and implement strict fluid balance charting
- Serial weights
- B-type natriuretic peptide
- Troponin if ACS suspected
- ABG
Initial ABCDE approach
Follow usual ABCDE approach if critically ill.
Treatment – POND
- Position (sit up)
- Oxygen (high-flow initially; titrate to keep oxygen saturations 92-96%, consider CPAP on CCU or HDU if required)
- Nitrates in severe pulmonary oedema (GTN infusion if SBP >110, or 2 puffs GTN spray if SBP 90-110)
- Diuretic if fluid overloaded or usually on it (e.g. furosemide 40mg IV initially)
- +treat cause
Identify and treat cause
- ACS → see notes on ACS
- Arrhythmia → see notes on arrhythmias
- Tamponade → pericardiocentesis
- Acute aortic/mitral regurgitation → valve replacement
- Hypertensive crisis → BP management
- Fluid overload → regular furosemide
Further interventions if required
- CPAP if hypoxaemic despite above interventions
- Inotropes ± intra-aortic balloon pump in ICU if in cardiogenic shock (hypotension + overload)
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What is the formula to determine cardiac output?
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What is preload, contractility and afterload? How are they related to stroke volume? What happens to these in heart failure?
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How do nitrates work in severe pulmonary oedema?
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In a patient admitted with fluid overload receiving intravenous diuresis, what is your daily fluid balance and weight loss target?
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