Breathlessness HF

Breathlessness HF

1. OATES, how far can you walk, pillows at night, ankle swelling

2. Other features: tachycardic, salt and water retention, hypotensive

3. Chronic remodelling of Left Ventricle

   • Ventricle dilates (spherical left ventrical)
   • tense chordae tendonae

4. Systolic HF

   • Heart is not contracting hard enough in systole
   • Causes: 66% CHD (HTN+DM), HTN, valvular HD (AS)
   • Dilated cardiomypathy causes: viral infection, alcohol, chemotherapy, genetic
     • Recovery when abstinence from alcohol
   • All patients will also have diastolic impairment

5. Diastolic HF

   • Heart is not relaxing enough in diastole
   • HF with preserved systolic function
   • LV hypertrophy: hypertrophy, hypertrophic cardiomyopathy
     • Commonest cause is HTN
   • No medication confirms survival benefit
   • Chronic AF
     • CO is reduced
     • Stiff LV
   • Pericardial disease
   • Mx symptomatically: diuretics, amlodipine

6. Ix

   • ProBNP: normal in untreated patient rules out HF
     • Reduced by drugs that decrease LV filling pressures: diuretics, ACEi, A2 blockers, Vasodilators, digoxin
   • ECHO

7. Mx

   • Loop diuretics: only symptomatic benefit, no prognostic benefit
   • ACEi: suppress angiotensin II and enhance kinins
     • Improves LV filling pressures
     • Modifies cardiac remodelling, reduce ventricular size
     • Improves Sx and haemodynamics
     • Modest increase in EF
     • Reduce mortality by 35% due to halting worsening HF
   • Beta-blockers
     • 34% reduction in mortality
     • Reduction in sudden death by 44%
     • Improve EF by 10%
     • Reduce progression of HF
     • Offer to ALL patients (except asthmatics)
     • Start low and go slow
     • If need to stop, gradual decrease and withdrawal
   • Lifestyle
     • STOP smoking
     • Reduce/abstain alcohol
     • Dietary advice, avoid salt and salty foods
     • Weight control with daily weights
     • Fluid restrict if severe and appropiate
     • Vaccinations
     • Stop all CI medications
       • NSAIDS, Ca channel blockers, glitazones

8. ACUTE: Stop B-blockers, re-introduce when stable, maintain perfusion of vital organs, FUROSEMIDE