Heart and ventricular failure

Causes  of heart failure-
Diabetes
Obesity
Smoking
Hypertension (High Blood Pressure)
Heart attack
Depression
Inherited heart defects
Congenital heart defects
Anaemia
Sleep disorders
Hyperthyroidism
Hypothyroidism
Faulty heart valves
Myocarditis
Heart arrhythmias
Emphysema
Lupus
Haemochromatosis

Management of acute left ventricular failure-
Clinical features-
Fatigue
Dyspnoea
Frank pulmonary oedema
Paroxysmal nocturnal dyspnoea
Cough
Crepitation – after cyanosis
Hypoxia and cyanosis
Sweating
Tachycardia

 Routine –
Blood for complete blood count
Blood urea and serum electrolytes
X-ray chest P/A view
-Cardiomegaly
-Pulmonary odema
-Dilated pulmonary capillaries and upper lobe diversion
ECG may shows
-LVF
-Evidence of ischemia and hypertension
Specific : (To confirm the diagnosis)
Echocardiography
C-T scanning (To see the size shape of cardiac chamber)
Angiogram
Cardiac MRI

 General measures –
Bedrest with propped-up position
Oxygen inhalation
Salt restricted diet
Avoid of alcohol and salt or fluid retaining drugs e.g NSAIDs
Drug therapy-
Inj. Morphine 5-10 mg I/V stat slowly
If necessary can be repeated it 6-8 hourly
Inj. Prochlorperazine – to prevent morphine-induced vomiting

Diuretics (first line of treatment)-
Inj. Frusemide 40-80mg I?V state slowly
If necessary can be repeated it 12-hourly either in injection or tab 40mg form
Mist-KCL: 2 tsf tds as long as Frusemide used
Vasodilator : (if LVF is due to MI). e.g
-Venodilator : Glyceryl trinitrate
-Arterial dilator : hydralazine
-ACE-I (with caution): e.g

Captopril –
-Starting dose : 12.5 mg 8 hourly
-maintain dose : 50 mg 8 hourly
Inotropic agents : Diagoxin. (1st line therapy in patients with heart failure with atrial fibrillation)
Digitalisation (if LVF is due to hypertension)
Tab. Diagoxin. (1 tab = 0.25mg)
1st day : 6 tab. Stat & 2 tab 6 hours
2nd day : 1 tab. Three times daily then
3rd  day : 1 tab. Two times daily then – from
4th day : 1tab. Daily as maintenance dose unit the pulse rate 60/min

 If associated bronchospasm  present –
Inj. Aminophylline 250-500 mg infused over 10 min
Other drugs used
-Anticoagulant drugs
-Anti-arrhythmic drugs
-Antibiotic drugs

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