1. PREVENTION
1.1. lifestyle changes
1.1.1. Not smoking
1.1.2. staying physically active
1.1.3. controlling certain conditions such as hypertension
2. 4.PHARMACOLOGICAL INTERVENTION
2.1. Diuretics
2.1.1. IV lasix
2.1.1.1. Acts on loop of henle, diuretics inhibit reabsorption of Na and reduce water absorption. Hence, patient will produce more urine, and excessive fluid can be pass out.
2.1.1.1.1. Relieve fluid retention.
2.2. GTN
2.2.1. vasodilator
2.2.1.1. Decrease preload and afterload
2.3. Beta blockers
2.3.1. Carvedilol/metoprolol
2.3.1.1. Slow down heart rate, allow left ventricle to have time to fill up
2.4. ACE inhibitors
2.4.1. Lisinopril
2.5. Angiotensin Receptor Blocker (ARB)
2.5.1. Losartan/valsartan
2.6. Aldosterone Antagonist
2.6.1. Spironolactone
2.7. Peripheral Vasodilator
2.7.1. Nifedipine/Amlodipine
2.8. Cardiac Glycosides
2.8.1. Digoxin
2.9. Angiotensin Neprilysin Inhibitor (ARNI)
2.9.1. Entresto
3. 5. NON-PHARMACOLOGY INTERVENTION
3.1. positioning
3.1.1. Sit up right
3.2. airway management
3.2.1. Provide oxygen
3.2.1.1. To relieve dypsnea
3.3. Modification on diet
3.3.1. Reduce salt intake
3.3.1.1. 2-3gram per day
3.3.2. Fluid restriction
3.3.2.1. 2L/day of fluid
3.4. Rest during acute phase to minimise exertion
3.5. Monitor daily morning weight
3.5.1. To detect retention of sodium or fluid
3.6. intake output charting
3.7. Monitor renal function test
4. Management of a patient with congestive heart failure and acute pulmonary edema - a case study. Authors: AuCoin, Andrew Source: Canadian Journal of Respiratory Therapy (CAN J RESPIR THER), 2011 Spring; 47(1): 12-17. (6p)
5. 1. PRIMARY DIAGNOSIS
5.1. Normal BNP level is <100pg/ml
5.1.1. Patient's BNP level is 1500pg/ml
5.2. Heart failure (HF) is a clinical syndrome caused by structural and functional defects in myocardium resulting in impairment of ventricular filling or the ejection of blood. The most common cause for HF is reduced left ventricular myocardial function; however, dysfunction of the pericardium, myocardium, endocardium, heart valves or great vessels alone or in combination is also associated with HF. Some of the major pathogenic mechanisms leading to HF are increased hemodynamic overload, ischemia-related dysfunction, ventricular remodeling, excessive neuro-humoral stimulation, abnormal myocyte calcium cycling, excessive or inadequate proliferation of the extracellular matrix, accelerated apoptosis and genetic mutations
5.2.1. Signs & Symptoms
5.2.1.1. Lack of appetite
5.2.1.1.1. Loss of appetite
5.2.1.1.2. Anorexia
5.2.1.2. Orthopnea
5.2.1.2.1. Woke up from sleep at night, unable to catch breath
5.2.1.3. Dyspnea
5.2.1.3.1. SOB past 3 days
5.2.1.3.2. SP02 92% RA
5.2.1.3.3. RR 30/min,labored
5.2.1.4. Fatigue/Weakness
5.2.1.4.1. Gets tired easily
5.2.1.4.2. Verbalize loss of energy to do everything
5.2.1.5. Edema
5.2.1.5.1. 2+ pitting edema ankle & feet
5.2.1.6. Tachycardia
5.2.1.6.1. HR 130bpm
5.2.1.7. Irregular Heartbeat
5.2.1.7.1. Irregular HR
5.2.1.8. Reduced ability to exercise
5.2.1.8.1. Feeling breathless while taking stairs and performing activities
5.2.1.9. Persistent cough (with white or pink blood-tinged phlegm)
5.2.1.9.1. Frothy cough
5.2.1.10. Increased jugular venous pressure
5.2.1.10.1. Distended neck veins
5.2.2. Left-sided heart failure
5.2.2.1. HFpEF(Diastolic failure) HFrEF(Systolic failure)
5.2.2.1.1. In LV failure, the most common symptoms are dyspnea and fatigue due to increased pulmonary venous pressures, and low CO (at rest or inability to augment CO during exertion). Dyspnea usually occurs during exertion and is relieved by rest. As HF worsens, dyspnea can occur during rest and at night, sometimes causing nocturnal cough. Dyspnea occurring immediately or soon after lying flat and relieved promptly by sitting up (orthopnea) is common as HF advances. In paroxysmal nocturnal dyspnea (PND), dyspnea awakens patients several hours after they lie down and is relieved only after they sit up for 15 to 20 minutes.
5.2.3. Right-sided heart failure
5.2.3.1. In RV failure, the most common symptoms are ankle swelling and fatigue. Sometimes patients feel a sensation of fullness in the abdomen or neck. Hepatic congestion can cause right upper quadrant abdominal discomfort, and stomach and intestinal congestion can cause early satiety, anorexia, and abdominal bloating.
5.2.4. Bi-ventricular heart failure
6. 3. DIAGNOSTIC INVESTIGATIONS
6.1. Echocardiography
6.1.1. PA dilatation.
6.1.1.1. A substantial increase in pulmonary vascular resistance might be associated with a midsystolic notch on pulmonary valve pulsed-wave Doppler ejection wave and a short pulmonary valve acceleration time
6.1.2. RV dilatation.
6.1.2.1. Increased right ventricular afterload leads to a reduction in right ventricular systolic function, as demonstrated by tricuspid annular plane systolic excursion on M-mode echocardiography across the tricuspid annulus.
6.1.3. RV dysfunction.
6.1.4. Normal or hyper dynamic LV.
6.1.4.1. Prolonged left ventricular wall tension suppresses early transmitral filling, resulting in an isolated late-diastolic transmitral A wave.
6.1.5. Septal flattening.
6.1.5.1. The presence of prolonged long-axis shortening, measured by M-mode echocardiography across the base of the left ventricle
6.2. MRI cardiac
6.2.1. MRI plays a pivotal role in various aspects of cardiac failure. It is useful in establishing the diagnosis and etiology. It enables risk stratification, provides prognostic information, and determines suitability for surgical/interventional procedures. The presence of scar or fibrosis implies adverse prognosis in several conditions that cause cardiac failure.
6.2.1.1. Ground glass opacification
6.2.1.2. Bronchovascular bundle thickening (due to increased vascular diameter and/or peribronchovascular thickening)
6.2.1.3. Interlobular septal thickening
6.2.1.4. Alveolar oedema is demonstrated by airspace consolidation
6.3. Coronary angiogram
7. https://emedicine.medscape.com/article/163062-overview
8. Heart Failure (HF) - Cardiovascular Disorders - Merck Manuals Professional Edition
9. https://emedicine.medscape.com/article/157452-clinical
10. Heart Failure: Diagnosis, Management and Utilization
11. 2. Secondary Diagnosis : Pulmonary Oedema
11.1. Cardiac depression may also cause fiuid to back up into the pulmonary system, resulting in pulmonary edema. Patients with CHF may experience a variety of symptoms with physical exertion, or at rest with increasing disease severity
11.2. Findings related to patient
11.2.1. Bilateral Crackles in lower lung bases
11.2.2. Cardiomegaly seen in CXR
11.2.3. Redistribution seen in CXR