Diagnosis
n/a
Investigation
- BNP > 100 ng/l or N terminal pro BNP > 300 ng/l
- If raised perform Trans-thoracic Doppler 2D to establish whether cardiac abnormality
Management
- Acute: IV diuretic, start with bolus or infusion
- Do NOT routinely offer nitrates (preload) or opiates (afterload)
- Do NOT routinely offer inotropes of vasopressors unless in reversible cardiogenic shock, and only then in CCU setting
- IV nitrates used in special circumstances: concomitant MI or severe HTN then monitor in level 2 bed
- Closely monitor renal function, U/O
- Non-invasive ventilation: if cardiogenic pulmonary oedema
- Invasive ventilation: if respiratory failure or physical exhaustion
- Ultra-filtration only if diuretic resistance
Treatment after stabilisation:
- Stable left ventricular failure: Start or restart Beta Blockers, once diuretics no longer needed
- Stable left ventricular failure: ACE inhibitor + Aldosterone antagonist
- Monitor BP, HR, U+Es
Valvular surgery
- Offer aortic replacement if failure due to severe aortic stenosis, or mitral replacement if HF due to severe mitral regurgitation
- TAVI should be offered to those unsuitable for surgery
Mechanical assist
- with reversible severe heart failure, or candidate for transplantation