Diferencia entre revisiones de «Congestive heart failure»
(→DDX) |
|||
| Línea 42: | Línea 42: | ||
==DDX== | ==DDX== | ||
#Cardiovascular | #Cardiovascular | ||
##ACS | ##[[ACS]] | ||
##Acute | ##[[Acute Valve Dysfunction]] | ||
##Aortic Dissection | ##[[Aortic Dissection]] | ||
##Dysrhthymia | ##[[Dysrhthymia]] | ||
##Endocarditis | ##[[Endocarditis]] | ||
##Hypertensive | ##[[Hypertensive Emergency]] | ||
##Pericardial | ##[[Pericardial Tamponade]] | ||
#Pulmonary | #Pulmonary | ||
##COPD | ##[[COPD]] | ||
##PE | ##[[PE]] | ||
##PNA | ##[[PNA]] | ||
#Other | #Other | ||
##Pure volume overload | ##Pure volume overload | ||
###Renal | ###[[Renal Failure]] | ||
###Post- | ###Post-[[Transfusion]] | ||
##Sepsis | ##[[Sepsis]] | ||
===Causes of Decompensation=== | ===Causes of Decompensation=== | ||
#Medication noncompliance | #Medication noncompliance | ||
#Dietary noncompliance | #Dietary noncompliance | ||
#Uncontrolled HTN | #Uncontrolled [[HTN]] | ||
#MI | #[[MI]] | ||
#Valvular | #[[Valvular Dysfunction]] | ||
#Arrhythmias | #[[Arrhythmias]] | ||
#Infection | #Infection | ||
#Inappropriate medications (e.g., negative inotropes) | #Inappropriate medications (e.g., negative inotropes) | ||
#Fluid overload | #Fluid overload | ||
#Missed dialysis | #Missed dialysis | ||
#Thyrotoxicosis | #[[Thyrotoxicosis]] | ||
#Anemia | #[Anemia]] | ||
#Alcohol | #[[Alcohol Withdrawal]] | ||
==Treatment== | ==Treatment== | ||
===Acute Pulmonary Edema and Hypertensive Heart Failure=== | ===Acute Pulmonary Edema and Hypertensive Heart Failure=== | ||
Revisión del 13:51 6 abr 2012
Background
- Assume valvular problem in new-onset CHF
- Assume valve thrombosis in CHF w/ a prosthetic valve
- Do not give vasodilators in AS, HOCM; yes in MR
NYHA Classes
- No Sx
- Sx with every day activity
- Severely limits activity
- Sx at rest
Etiology
- CAD
- HTN
- Cardiomyopathy
- Valvular
- High-output
- Post-partum
- Tamponade
- Dysrhythmias
Diagnosis
- CBC (r/o anemia)
- Chem
- ECG
- CXR
- Cephalization
- Interstitial edema
- Pulmonary venous congestion
- Pleural effusion
- Alveolar edema
- Cardiomegaly
- Troponin?
- BNP?
- <100 (Sn 90%, NPV 89%)
- > 500 (Sp 87%, PPV 90%)
- Elevated in:
- Elderly, kidney failure, PE
- Decreased in:
- Obese
DDX
- Cardiovascular
- Pulmonary
- Other
- Pure volume overload
- Renal Failure
- Post-Transfusion
- Sepsis
- Pure volume overload
Causes of Decompensation
- Medication noncompliance
- Dietary noncompliance
- Uncontrolled HTN
- MI
- Valvular Dysfunction
- Arrhythmias
- Infection
- Inappropriate medications (e.g., negative inotropes)
- Fluid overload
- Missed dialysis
- Thyrotoxicosis
- [Anemia]]
- Alcohol Withdrawal
Treatment
Acute Pulmonary Edema and Hypertensive Heart Failure
See Pulmonary Edema
Hypotensive Heart Failure
Heart Failure Without Pulmonary Edema
- UNLOAD+
- Upright Position
- Nitrates
- Consider nitroprusside 0.3 mcg/kg/min if NTG ineffective
- Lasix
- Give nitrates first
- Oxygen
- ACEI
- Enalaprilat 0.004mg/kg as IVB or 1mg gtt over 2hr
- Avoid in pregnancy, hyperK+
- Enalaprilat 0.004mg/kg as IVB or 1mg gtt over 2hr
- Digoxin
- Indicated for a fib rate control
- CPAP/BiPAP
Disposition
Admission Criteria (AHCPR '00)
- ACS
- Pulm edema/resp distress
- O2 sat < 90% on room air
- Severe complicating illness
- CHF refractory to outpt therapy
- Anasarca
- Symptomatic hypotension or syncope
- Arrythmia (e.g. new a. fib)
- Inadequate outpt support
See Also
Source
EB Medicine, UpToDate, DONALDSON (adapted from Lampe)