Heart failure History Symptoms -fatigue, exertional dyspnoea ( NYHA class), orthopnea, PND, - fatigue, breathlessness, anorexia, nausea ( bowel edema), ankle swelling, abdominal distended/tense Causes ( past hx) -IHD : chest pain(exertional/rest), palpitation, sweating & other symptoms -systemic hypertension (high) - arrhythmia : palpitation, SOB - Chronic lung disease : COAD symptoms → co-pulmonale -pulm. Embolism : sudden SOB then fever, Hx DVT -Valvular heart disease , cong. Heart disease Precipitating -ischemia ( MI), arrhythmia, infection, electrolyte imbalance - discontinuation of medication -pregnancy, high salt intake, thytotoxocosis Coronary risk factor -Age , male -HPL, , dm, OCP, premature menopause, obesity - smoking, less physical actvt - Hx of angio done -Family history of early coronary heart disease Other: -medication currently taken D.D. of SOB -lung: pneumonia, TB, asthma, COAD, bronchectasis,lymphoma,mesothelioma,lung ca -heart: IHD,MI -CNS: myasthenia gravis, phrenic nerve palsy, PE Sign of fluid retention : raised JVP, lung crep, pitting edema, tender hepatomegaly, ascites, pleura effusion (commonly at rt side) Sign of impaired perfusion : cold clammy skin, low BP Sign of vent dysfunction : displaced apex beat, Rt vent. Heave, S3/ S4 heard, functional MR ( d/t dilatation of mitral annulus) @ tricuspid regurge, tachycardia Gallop rhythm : present S3/S4 with tachycardia Other significant : BP( lying & standing), obesity (BMI), heart rate Diagnosis : decompensate/ compensated CCF d/t ______ and limited with NYHA class ____ Ix Diagnostic -CXR- size heart and sign of Lt heart failure (ABCDE), sign of lung disease -ECG-aschemic , arrhythmia, Lt vent hyperthropy - Echo – see ejection fraction < 45% = Lt.failure, valvular disease,cardiac chamber size, - FBC – anemia as causes - BUSE – hypoK+ (arrhythmia) hypoNa+ (in severe long standing cardiac failure and poor prognosis), Renal fail Tx -Stabilize patient ABC- -Give O2, IV frusemide, -SBP >100 give isoket,if less give dopamine, dobutamin -morphine in dyspnoeic and restless pt ( caution for chr. respiratory disease) -treat precipitating factor if present -monitor BP,PR,RR,O2,I/O -beta-blocker, ACEI, spirinolactone ,
Posted on: Fri, 14 Jun 2013 02:16:04 +0000
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