HEART FAILURE

NURUL NAJWA ZULKIFLI

 INVESTIGATION
• To confirm dx and
determine type of
HF and aetiology:
• Basic inv : ECG, CXR,
Blood, Urine test
• Echocardiography –
determine type of
HF and identify
structural cardiac
defect
• Regular BP or continuous intra-arterial BP
monitoring
• UO (renal perfusion), alertness and conscious
level
• Assessment of venous pressure:
• CVP
• Pulmonary capillary wedge pressure (PCWP) with
Swan-Ganz catheter
• Suspect ARDS, exclusion of VSD, asso hypotension
needing rx with inotropes
Optimal Cut Points for Diagnosis or
Exclusion of HF among patient with
Dyspnoea
BNP (ng/L) NTproBNP (ng/L)
HF rule out <100 <300
HF possible >400 Age <50 : >450
Age 50-75 : >900
Age >75 : >1800
 MANAGEMENT
1. Priorities • Position:
Upright – improves pulmo fx
2. Oxygenation Supine/Trendelenburg – in hypotensive pts
3. Fluid challenge • Oxygen 35-100% via facemask – maintain PaO2>60mmHg or
SaO2>90%
4. Diuretics • Treat underlying arrhythmias
• IV cannula:
5. Vasodilators • Morphine 2.5-5mg + metoclopramide 10mg IV/IM
6. Inotropes * reduces anxiety and systemic vasodilatation
**avoided or use with care if hypotension
7. Others • Frusemide 40-80 mg IV
• Sublingual nitrate 0.3-0.5mg if BP >100mmHg
• Further rx based on SBP
• >100 : further diuretics + vasodilators
• <100 : [cardiogenic shock] inotropes
• Hypoperfusion:
• cold peripheries,
• CFT > 2 seconds,
• diaphoresis,
• oliguria,
• dizziness,
• confusion,
• narrow pulse pressure,
• hypotension.

• Congestion:
• peripheral oedema,
• orthopnoea,
• paroxysmal nocturnal dyspnoea,
• lung crepitations,
• jugular venous dilatation,
• hepatojugular reflux,
• congested hepatomegaly,
• gut congestion,
• ascites
Reference:
• CPG Malaysia, Heart Failure 4th
ed, 2019
• Sarawak Handbook of
Emergency Medicine
• Tintinalli’s Emergency
Medicine