Congestive heart failure: Difference between revisions
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==Work-Up== | ==Work-Up== | ||
Key Historical Questions | |||
* History of heart failure? | * History of heart failure? | ||
* Have you been taking your meds? | * Have you been taking your meds? | ||
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* CP? | * CP? | ||
* Syncope? | * Syncope? | ||
Studies | |||
* CBC (r/o anemia), chemistry | * CBC (r/o anemia), chemistry | ||
* ECG | * ECG | ||
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* Troponin? | * Troponin? | ||
* BNP? | * BNP? | ||
* <100 (90% Sn) | ** <100 (90% Sn) | ||
* > 500 (87% Sp) | ** > 500 (87% Sp) | ||
* Elevated in: | ** Elevated in: | ||
* Elderly, kidney failure, PE | *** Elderly, kidney failure, PE | ||
* Decreased in: | ** Decreased in: | ||
* Obese | *** Obese | ||
DDX | DDX | ||
* Cardiovascular | * Cardiovascular | ||
* ACS | * ACS | ||
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* Post-transfusion | * Post-transfusion | ||
* Sepsis | * Sepsis | ||
===Causes of Decompensation=== | ===Causes of Decompensation=== | ||
* Medical noncompliance | * Medical noncompliance | ||
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* PE | * PE | ||
===Underlying Etiology=== | ===Underlying Etiology=== | ||
* CAD | * CAD | ||
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* Post-partum | * Post-partum | ||
==Treatment== | ==Treatment== | ||
* UNLOAD+ | * UNLOAD+ | ||
* Upright Position | ** Upright Position | ||
* Nitrates | ** Nitrates | ||
* Consider nitroprusside if NTG ineffective | *** Consider nitroprusside if NTG ineffective | ||
* Lasix | ** Lasix | ||
* Oxygen | ** Oxygen | ||
* ASA | ** ASA | ||
* Digoxin | ** Digoxin | ||
* Indicated for a fib rate control | *** Indicated for a fib rate control | ||
* ACEI | * ACEI | ||
** Enalaprilat 0.004mg/kg as IVB or 1mg gtt over 2hr | |||
*** Avoid in pregnancy, hyperK+ | |||
* Enalaprilat 0.004mg/kg as IVB or 1mg gtt over 2hr | |||
* Avoid in pregnancy, hyperK+ | |||
* BiPAP | * BiPAP | ||
==Disposition== | ==Disposition== | ||
Revision as of 01:51, 3 March 2011
NYHA Classes
1) No Sx
2) Sx with every day activity
3) Severely limits activity
4) Sx at rest
Work-Up
Key Historical Questions
- History of heart failure?
- Have you been taking your meds?
- Any recent changes in medication?
- SOB while: lying flat, walking, middle of night?
- CP?
- Syncope?
Studies
- CBC (r/o anemia), chemistry
- ECG
- CXR
- Troponin?
- BNP?
- <100 (90% Sn)
- > 500 (87% Sp)
- Elevated in:
- Elderly, kidney failure, PE
- Decreased in:
- Obese
DDX
- Cardiovascular
- ACS
- Acute valve dysfunction
- Aortic Dissection
- Dysrhthymia
- Endocarditis
- Hypertensive crisis
- Pericardial tamponade
- Pulmonary
- COPD
- PE
- PNA
- Other
- Pure volume overload
- Renal failure
- Post-transfusion
- Sepsis
Causes of Decompensation
- Medical noncompliance
- Dietary noncompliance
- ACS
- Dysrhythmia
- Uncontrolled HTN
- Infection
- Anemia
- Thyrotoxicosis
- PE
Underlying Etiology
- CAD
- HTN
- Cardiomyopathy
- Valvular
- High-output
- Post-partum
Treatment
- UNLOAD+
- Upright Position
- Nitrates
- Consider nitroprusside if NTG ineffective
- Lasix
- Oxygen
- ASA
- Digoxin
- Indicated for a fib rate control
- ACEI
- Enalaprilat 0.004mg/kg as IVB or 1mg gtt over 2hr
- Avoid in pregnancy, hyperK+
- Enalaprilat 0.004mg/kg as IVB or 1mg gtt over 2hr
- BiPAP
Disposition
Admission Criteria (AHCPR '00)
1. ACS
2. Pulm edema/resp distress
3. O2 sat < 90% on room air
4. Severe complicating illness
5. CHF refractory to outpt therapy
6. Anasarca
7. Symptomatic hypotension or syncope
8. Arrythmia (e.g. new a. fib)
9. Inadequate outpt support
See Also
Cards: CHF Meds
Source
EB Medicine, UpToDate, DONALDSON (adapted from Lampe)