| Exacerbation of congestive heart failure (a) (b) |
- Typical symptoms:
- breathlessness (on exertion, at rest, on lying flat, nocturnal cough, waking from sleep);
- fluid retention (ankle swelling, abdominal swelling, weight gain)
- Fatigue, reduced exercise tolerance
- Syncope or light headedness
- Risk factors:
- Coronary heart disease (myocardial infarction, hypertension, atrial fibrillation, diabetes, obesity)
- Drugs and alcohol
- Family history of heart failure or sudden cardiac death
- Examine for:
- Tachycardia (HR > 100), pulse rhythm
- High or low blood pressure
- Hypoxia
- Elevated JVP
- Tachypnoea, basal creps, pleural effusions
- Dependent oedema (ankles, sacrum), ascites
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Exacerbation of heart failure in a person with known reduced ejection fraction:
- Relieve symptoms of fluid overload:
- Titrate loop diuretics
- If symptoms are not relieved with maximum dose diuretic, seek specialist advice
- Once exacerbation controlled, consider an ACE inhibitor and a beta-blocker, start one at a time
- Consider antiplatelet treatment, statin (e.g. for coronary heart disease)
- Screen for depression and anxiety
- Exercise-based group rehabilitation program
- Think about advance care planning
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