(Acute & Emergency) (Peri-Op & Anaesthesia) (Clinical Imaging) (Medicine of Elderly) (Palliative Care)

Overview

• Inability of the cardiac output to meet the body’s demands, despite normal venous pressures
• Most common in patients >65 years old
• Left Heart Failure → IHD, Hypertension, Cardiomyopathy, Aortic valve disease, Mitral regurgitation, Arrhythmias
  • Systolic (HFrEF <40%, unable to pump) ⇒ ischaemic heart disease, dilated cardiomyopathy, myocarditis, arrhythmias
  • Diastolic (HFpEF >50%, heart can’t relax and properly fill with blood) ⇒ hypertrophic obstructive cardiomyopathy, restrictive cardiomyopathy, constrictive pericarditis, cardiac tamponade
• Right Heart Failure → Secondary to left heart failure (congestive heart failure), Infarction, Pulmonary hypertension, Tricuspid regurgitation
  • LHF + RHF ⇒ congestive heart failure
• May be chronic or acute
• May be low output state (low cardiac output) or high output state (normal cardiac output, but higher metabolic needs)
  • High Output (normal heart is unable to pump enough blood to meet the metabolic needs of the body) = anaemia, beri-beri (thiamine deficiency), pregnancy, hyperthyroidism

Making Diagnosis

Clinical Features:

• Left Heart Failure (fluid accumulation in lungs = pulmonary symptoms) → dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, fatigue, wheeze, bibasal crackles, cough, pink frothy sputum (as a result of pulmonary oedema). S3 gallop rhythm is an early sign of left ventricular failure.
• Right Heart Failure (fluid accumulates in peripheries = swollen signs) → swollen ankles (peripheral oedema), increased weight, reduced exercise tolerance, raised JVP, hepatomegaly (pulsatile liver edge on palpation), ascites

<aside> 💡 Left Sided HF = Pulmonary Oedema. Right Sided HF = Peripheral Oedema (Fluid congested backwards)

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Investigations:

• BNP (1st Line) → if raised suggests diagnosis of cardiac failure. Sensitive but not specific.