LVF treatment and management not done GRS!!!

what is your treatment

• reduce anxiety + keep comfortable

• oxygen therapy

• st upright

• GTN

• furosemide

• morphine

• CPAP in pts in respiratory distress

GTN in HF

• frequently used for symptomatic relief

• they theoretically decrease venous tone optimising preload and increase arterial tone decreasing after load

• consequently thought to increase stroke volume

GTN action

• dilation of coronary arteries

• dilation of systemic veins resulting in lower pre-load

• reduced BP

GTN indication

• acute heart failure with ischaemia or uncontrolled hypertension

GTN contraindication

• hypotension (systolic below 90)

• hypovolemia

• head trauma

• cerebral haemorrhage

• viagra use

• unconscious patients

• known severe aortic or mitral stenosis

furosemide action

• inhibits electrolyte reabsorption from kidneys

• enhances excretion of water from the body

• potent diuretic with rapid onset (within 30 mins) and short duration

furusemide indication

• pulmonary oedema

• respiratory distress as a result of acute heart failure

furosemide contraindication

• reduced GCS with liver cirrhosis

• Cardiogenic shock

• severe renal failure

• children under 18

when should morphine be used in heart failure?

• if pt is complaining of chest pain

cpap in heart failure

• should be considered in patients in respiratory distress

• start as soon as possible to reduce resp distress and rate of intubation

• research shows CPAP increases survival chances and reduces need to intubate

how does CPAP work in heart failure

• splints open collapsing alveoli, increasing intra-alveoli pressure

• increased pressure helps shift fluid in alveoli back into capillaries reducing pulmonary oedema

• raises intrathoracic pressure