B Y K E R R Y M O R T O N

DECOMPENSATING HEART FAILURE

DEFINITION

“The new onset or recurrence of symptoms and signs of heart failure requiring urgent or emergency treatment and resulting in seeking unscheduled hospital care.”

Many patients may have a gradual worsening of symptoms that reach a level of severity necessitating urgent care.

SYMPTOMS

Breathlessness

Worsening chronic heart failure Fluid overload, chest congestion, pulmonary oedema, pleural

effusions Chest infection Rhythm abnormalities Anaemia Pulmonary Embolus Anxiety Cancer Lung disease

Asthma COPD Bronchiectasis Emphysema

Ascites

Ascites

Abdominal discomfort

Liver congestion

Nausea

Feeling full/bloated

Increased breathlessness

Decreased mobility

Other symptoms

Dizziness

Weight gain

Reduced mobility

Palpitations

Chest pain

Arrhythmias

Lethargy/insomnia

Cognitive impairment Forgetfulness

Poor understanding

Monitoring

Daily weights – response to loop diuretic

Fluid intake – restrict to 1.5 litre per day

Renal function – U&Es

Cognitive impairment Concordance

Understanding of condition

Liver function - LFTs

Blood pressure

Heart rate – ECG

Response to medication changes and diuretics

Treatment

Oral or IV loop diuretics Bumetanide or furosemide

IV furosemide

Medications Rate control

BP control

A reduction in medications affecting the kidneys

Other diuretics Thiazide or thiazide like medications

Mineralocorticoid Receptor Antagonists – MRAs – Spironolactone and Eplerenone

Where do we treat

At home – oral diuretics

HFSN

GP

Hospital admission

Ward

CCU/ITU

AID-HF (Ambulatory Intravenous Diuretic for Heart Failure)

HFSN

Consultant Cardiologist

Cardiogenic Shock

Hypotension

Organ hypoperfusion despite adequate fluid resuscitation

Poor perfusion to peripheries

Cold and clammy

End organ dysfunction; renal, hepatic and central nervous system is common

Poor perfusion to peripheries

Deteriorating Patient

Respiratory support CPAP or BIPAP

Renal Support/Management of fluid overload IV furosemide

CVVH

CVVHDF

Dialysis

Cardiac support Inotropes (Noradrenaline/Dobutamine)

Phosphodiesterase inhibitors (Milrinone)

Monitored level 2/3 bed

GTN infusion – ward level

Conclusion

Patients with chronic heart failure can gradually or acutely deteriorate resulting in a hospital admission

Early intervention may prevent this progression

Education, monitoring and changes in treatment will assist in preventing such admissions