Heart failure March 2018 | by EMauthor Occurs when the heart is unable to pump blood at a rate required by metabolizing tissues. Caused by Ischaemic, valvular, hypertensive or congenital heart disease, cardiomyopathy, myocarditis, endocarditis, pulmonary embolism (PE). Precipitated bymyocardial infarction, infection, arrhythmia, anaemia, thyrotoxicosis, electrolyte disturbance, PE. Clinical features •Left-sided heart failure (HF): dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, fatigue, lung crepitations, pleural effusions, cyanosis •Right-sided HF: peripheral oedema, abdominal distension/ascites, tender pulsatile hepatomegaly, T jugular venous pressure (IVP), hepatojugular reflux •Severe HF: reduced pulse pressure, hypotension, cool peripheries, 3rd i 4th heart sounds, gallop rhythm. Investigations and treatment •Bloods, ECG •Chest X-ray, echo if skilled •Treat any risk factor (cholesterol reduction, glycaemic control, weight loss, smoking cessation etc.); remove any precipitant •Diuretics, ACE inhibitors or angiotensin receptor blockers, B-blockers, digoxin, GTN infusion
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