Congestive heart failure

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Background

NYHA Classes

1) No Sx

2) Sx with every day activity

3) Severely limits activity

4) Sx at rest

All classes = 5 yr mortality ~ 60%

Classes III,IV = 1 yr mort up to 70%

Work-Up

1. CBC

2. ECG

3. CXR

4. Chem 7

5. BNP?

6. If CP --> R/O


DDX

1. 'Neglected' chronic CHF

2. MI

3. HTN Crisis

4. Acute valvular insuff

  • endocarditis
  • MV dysfx
  • aortic dissection
  • prothetic valve dyfx

5. Brady/tachy arrythmia


Causes Decomp

1. Medical noncompliance

2. Dietary noncompliance

3. Arrythmia

4. Infection

5. Anemia

6. Renal dysfx

7. ACS

8. Hyperthyroid

9. PE


Underlying Etiology

1. CAD

2. HTN

3. Cardiomyopathy

4. Valvular


Treatment

UNLOAD+

Upright Position

Nitrates

Lasix

Oxygen

ASA

Dig (if indicated)


Enalapril

BiPAP


Disposition

Admission Criteria (AHCPR '00)

1. ACS

2. Pulm edema/resp distress

3. O2 sat < 90% on room air

4. Severe complicating illness

5. CHF refractory to outpt therapy

6. Anasarca

7. Symptomatic hypotension or syncope

8. Arrythmia (e.g. new a. fib)

9. Inadequate outpt support

10. (new-onset CHF of unclear etiology @Harbor)


See Also

Cards: CHF Meds


Source

7/2/09 DONALDSON (adapted from Lampe)