Condition Info - BotMed Application

ConditionName

Congestive heart failure (CHF)

ConditionDescription

Symptoms

SOB; Edema; Intolerance to exercise; Orthopnea; S3 gallop;
Nocturnal dyspnea; HJR; Frothy white sputum with flecks of blood
Hepatosplenomegaly; Cardiac enlargement; Anxiety

RCHF: JVD; Ascites; Peripheral edema

PhysicalFindings

JVP, S3 gallop, Orthopnea, wet crackles (pulmonary edema), pitting edema, may be ascites, big LV, SP; Crackles;

ClinicalTests

CBC, creatine, electrolytes, urea, albumin, uric acid, ALT/AST, fasting; glucose, lipid panel, TSH, UA;
Specific to HF: BNP, iron panel, ferritin, transferrin, HIV test;
Best initial test: Transthoracic ECG , Echo(echocardiography) – can help to distinguish systolic from diastolic disfunction);
BNP > 500 – is CFH present? If patient has SOB;
Most accurate test: MUGA scan;
Chest x-ray (enlarged heart, effusion);
Hyperventilation causes low CO2 and hypoxia (respiratory alkalosis);

Test which can alter acute management: 
ECG – check them! Pulmonary edema possible.

RiskFactors

Smoking, DM, obesity, hyperlipidemia, HTN, anemia, liver disease, arrhythmia, supraventricular arrhythmia, kidney disease, CAD 

Causes: 
Hypothyroidism; Pregnancy; Thiamin def; Arrhythmia; Systemic infection; MI
Renal failure; Medication (BB, disopyramide); Increased fluid load; HIV

IsRedFlag

IsNPLEX

Consequence

Most common cause of death: arrhythmia, sudden death, ischemia;
Anxiety;

ProgressionFromCondition

Cardiomyopathy;
Arrhythmia;
Diseases of the heart valve;
Congenital heart conditions;
Myocarditis;
Medicines and chemicals including some chemotherapy drugs and cocaine;
Excessive alcohol consumption;
Anemia;
Thyroid gland disease (Hypo- or Hyper);

TreatmentOptions

PharmOptions

Systolic:
ACE or ARB – for systolic dysfunction (both can cause high K)
BB – Carvedilol (beta and alpha), metoprolol low mortality. Anti-ischemic, antiarrhytmic, decreases O2 consumption, decrease HR

Spironolactone (aldosterone antagonist! 
Decrease salt consumption. 
Decrease stress.
Can cause gynecomastia and high K)

Diuretics – decrease fluide overload, but not decrease mortality. Management of acute pulmonary edema. Furosemide (loop)
Digoxin (works slow, not for acute pulmonary edema) – not decrease mortality, for systolic CFH, decreases frequency of hospitalisation and symptoms
Diastolic:
Less clear.
BB, not no mortality benefit
Digoxin – no benefit
Diuretics for symptoms relieve, but not for obstructive

WebLink

https://www.merckmanuals.com/en-ca/professional/cardiovascular-disorders/heart-failure/heart-failure-hf