Congestive heart failure

Background

NYHA Classes

1) No Sx

2) Sx with every day activity

3) Severely limits activity

4) Sx at rest

All classes = 5 yr mortality ~ 60%

Classes III,IV = 1 yr mort up to 70%

Work-Up

1. CBC

2. ECG

3. CXR

4. Chem 7

5. BNP?

6. If CP --> R/O

DDX

1. 'Neglected' chronic CHF

2. MI

3. HTN Crisis

4. Acute valvular insuff

endocarditis
MV dysfx
aortic dissection
prothetic valve dyfx

5. Brady/tachy arrythmia

Causes Decomp

1. Medical noncompliance

2. Dietary noncompliance

3. Arrythmia

4. Infection

5. Anemia

6. Renal dysfx

7. ACS

8. Hyperthyroid

9. PE

Underlying Etiology

1. CAD

2. HTN

3. Cardiomyopathy

4. Valvular

Treatment

UNLOAD+

Upright Position

Nitrates

Lasix

Oxygen

ASA

Dig (if indicated)

Enalapril

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

10. (new-onset CHF of unclear etiology @Harbor)

Source

7/2/09 DONALDSON (adapted from Lampe)