Patients presenting with AHF have a high mortality 4-10% in-hospital and 25-30% at 1yr, and 45% if re-admitted. So rapid diagnosis a treat is essential.
AHF Triggers
there are many triggers for AHF, which if recognized and treated with help improve outcomes
- Cardiac: ACS, Arrhythmia, Aortic Dissection, Acute Valve Incompetence, VSD, Malignant Hypertension
- Respiratory: PE, COPD
- Infection: Pneumonia, Sepsis, Infective endocarditis
- Toxins/Drugs: Alcohol, Recreational drugs, NSAIDs, Steroids, Cardiotoxic meds
- Increased Sympathetic Drive: Stress
- Metabolic: DKA, Thyroid dysfunction, Pregnancy, Adrenal Dysfunction
- Cerebrovascular Insult
Presentations
Decompensated Heart Failure
Isolated Right Vent-Failure
Pulmonary Oedema
Cardiogenic Shock
Managment
Treatment – Time Matters!!!
- Mortality increased by 1%/hour IV treatment not started
Treat The Cause!: If you can identify the trigger treat it it will in turn improve the AHF. (e.g. AMI, Arrythmia(Tachy/Brady), Massive PE)
Oxygen
- Not all patients should be given Oxygen ESC suggest maintain SaO2 >90%
- Early NIV is suggested if any of:
- RR >25bpm or SaO2 <90% despit oxygen
- Signs type 2 respiratory failure
Metanalysis suggests early NIV may reduce need for intubation and improve mortality
Diuretic
Vasodilator
Inotropes
