1. Heart Failure Chloe Hymers and Morag Sime

2. Aim Know the difference between left and right heart failure Be able to take a history specific to heart failure Understand how to investigate heart failure Know how to manage acute heart failure

3. Objectives (from your syllabus) Recognise left and right heart failure from the history and physical examination and relate them to underlying pathophysiological changes. Recognise the role of radiography, ECG and echo in the diagnosis of heart failure Initiate management of patients with heart failure by the appropriate use of diuretics, vasodilators and inotropes and monitor the response.

4. Pathophysiology Definition Left and right heart failure Causes

5. Alcoholic cardiomyopathy Infective Cancer treatment Coronary heart disease Hypertension Anaemia Hyperthyroidism Atrial fibrillation Congenital Valvular heart disease

6. History What symptoms? How would you ask the patient?

7. Examination What signs may be present?

8. Investigations Bedside tests Bloods Imaging Special tests

9. CXR findings A- alveolar oedema B- Kerley B lines C- cardiomegaly D- diversion to the upper lobes E- pleural effusion (bilateral)/pulmonary oedema

10. A

11. B

12. C

13. D

14. E

15. Management- chronic Conservative Medical Surgical

16. Management- acute ABC Sit up Furosemide GTN infusion

17. Case study 61 year old man 3 month history of malaise, SOB and ankle swelling. Short of breath walking up stairs. PMH- hypertension, MI, smoked 40 cigarettes for 40 years.

18. Questions Differential diagnosis Heart failure – COPD – Lung cancer – Angina – PE Explain cardiac rehabilitation

19. As an F1……. Most important thing is initial management in A and E and flash pulmonary oedema AKI vs Pulmonary oedema always a problem

20. Questions