1. Heart Failure James Masters

2. Rough outline Introduction overview Allocation of teams 5 minutes for signs and symptoms 5 minutes for investigations and management Imaging Questions

3. Learning Objectives 1.A clear and concise understanding of what heart failure is 2.Appreciate the clinical features of acute and chronic heart failure 3.Be able to provide the most common causes of heart failure

4. Global Definition Any volunteers?

5. A definition Heart failure is a clinical syndrome characterized by systemic perfusion inadequate to meet the body's metabolic demands as a result of impaired cardiac pump function

6. Different flavours Heart Failure Left and right Systolic and diastolic High output low output Preload and afterload

8. Symptoms Respiratory Cardiac Other

9. Examination Findings Left heart failure Tachypnoeic Weak radial pulse Cyanosis Displaced Apex Additional heart sounds May be signs of underlying cause Right heart failure Tachypnoeic Raised JVP Pulsatile hepatomegaly Peripheral oedema

10. Clinical Scenario Please take history

11. Clinical Scenario Please examine patient

12. Clinical Scenario A 61 year old gentleman presents to the GP surgery with a 3 month history of general malaise, increasing SOB and ankle swelling. He now gets SOB walking up stairs. He has a past medical history of hypertension, previous MI in 2008 and he has smoked 40 cigarettes a day for the past 40 years.

13. Differential Diagnosis

14. Important Heart failure COPD Malignancy

15. Investigations UBEXS? Urine Bloods ECG X-ray Special tests

16. Investigations Urine Bloods – FBC, U&E, LFTs, Bone, BNP ECG-clues X-ray-See later Special tests-Mulitple! Echocardiogram

17. Management Conservative Medical Surgical

18. Conservative Smoking cessation Alcohol Diet Weight loss Cardiac rehabilitation

19. Management Acute Sit up OYXGEN (high flow) IV MORPHINE 2.5-5.0 mg SL GTN 1-2 tabs ± IV GTN infusion 10-200 mcg/min (start high) PO/IV FUROSEMIDE 40 mg od (80 mg if creat 120-200; 120 mg if 200-400; 250 mg, if 400+) ± ?ACS protocol, if ?MI - ie Rx STEMI appropriately (PCI? Thrombolysis?) ± Rx of ?arrythmia ± Rx endocarditis Chronic Complex Briefly – Beta blocker – ACEi – Diuretic – Cause

22. Some examples

25. RIGHT SIDED PNEUMOTHORAX LEFT UPPER LOBE CONSOLIDATION