AHF In Critical Illness

DIAGNOSIS AND MANAGEMENT OF ACUTE HEART FAILURE IN CRITICALLY ILL PATIENTS

[object Object],[object Object],[object Object],[object Object],AHF

[object Object],[object Object],[object Object],AHF

[object Object],[object Object]

Early Recognition And Management Of The Patient With AHF ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Early Recognition And Management Of The Patient With AHF

[object Object],Early Recognition And Management Of The Patient With AHF Resuscitation

Resuscitation ,[object Object],[object Object],[object Object],Early Recognition And Management Of The Patient With AHF

[object Object],[object Object],[object Object],Early Recognition And Management Of The Patient With AHF Resuscitation Breathing

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Early Recognition And Management Of The Patient With AHF Resuscitation

Basic monitoring ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Early Recognition And Management Of The Patient With AHF

Clinical history ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Early Recognition And Management Of The Patient With AHF

Key questions Early Recognition And Management Of The Patient With AHF Clinical history ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Additional symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Early Recognition And Management Of The Patient With AHF Clinical history

[object Object],[object Object],Early Recognition And Management Of The Patient With AHF Clinical history Other imp points

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Other imp points Early Recognition And Management Of The Patient With AHF Clinical history

Physical examination ,[object Object],Early Recognition And Management Of The Patient With AHF Signs of AHF SIGNS OF CONGESTION SIGNS OF LOW CARDIAC OUTPUT Elevated JVP Cool peripheries Pulsus alternans Decreased level of consciousness Hepatojugular reflux Confusion Parasternal lift hypotension Displaced apical impulse Low volume carotid pulse Gallop rhythm Tachycardia or inappropriate bradycardia Murmur (MR,TR) Peripheral edema Ascitis, hepatomegaly

Assessment of severity of AHF ,[object Object],[object Object],[object Object],Early Recognition And Management Of The Patient With AHF

Assessment of severity of AHF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Early Recognition And Management Of The Patient With AHF

[object Object],Pressure overload HTN, AS, PE Impaired myocardial filling AR, Output failure Volume overload MS, Tmaponade, Pericardial constriction, restriction Myocardial disease IHD, myocarditis, Metabolic or toxic disease Dysrhythmias Brady or tachyarrhythmias

[object Object],[object Object],[object Object]

[object Object],Category of AHF Right and/or left heart failure Forward/backward heart failure This terminology describes whether the predominant problem is with forward flow (perfusion) or backward flow (congestion) Systolic and/or diastolic heart failure Diastolic heart failure is often presumed to be present when symptoms and signs of heart failure occur in the presence of preserved left ventricular systolic function

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Laboratory tests in AHF ,[object Object],[object Object],[object Object],[object Object],Diagnosis

[object Object],[object Object],[object Object],[object Object],Laboratory tests in AHF Diagnosis

[object Object],[object Object],[object Object],Diagnosis

[object Object],[object Object],[object Object],Diagnosis Echocardiography

Reducing demand ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Management

[object Object],Reducing demand Management

Increasing supply ,[object Object],[object Object],[object Object],[object Object],Management

Non-specific therapy ,[object Object],[object Object],Management

Ensuring adequate oxygenation ,[object Object],[object Object],[object Object],Management

Obtaining adequate heart rate and rhythm ,[object Object],[object Object],[object Object],[object Object],Management

[object Object],Management Obtaining adequate heart rate and rhythm

Optimization of preload ,[object Object],[object Object],[object Object],Management

Increasing cardiac output ,[object Object],[object Object],Management

Correction of structural problems ,[object Object],[object Object],[object Object],Management

Cardiogenic shock ,[object Object],[object Object]

[object Object],[object Object],[object Object],Cardiogenic shock

[object Object],[object Object],[object Object],Intra-aortic balloon pump Cardiogenic shock

Ventricular assist devices ,[object Object],[object Object],[object Object],[object Object],Cardiogenic shock

Left heart backward failure ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],Left heart backward failure

Right heart backward failure ,[object Object],[object Object],[object Object]

Conclusion Acute heart failure is a syndrome with a high mortality There are a large number of causes of this syndrome and it can present in a number of differing patterns that depend on the underlying pathophysiology It often presents with a different clinical picture compared to chronic heart failure Treatment is a combination of supportive measures and definitive therapy that depends on the aetiology

AHF 1-American Heart Association. Heart Disease and Stroke Statistics – 2005 Update. Dallas, TX: American Heart Association2005 . 2- Nieminen MS, Harjola V-P. Definition and Aetiology of acute heart failure syndromes. Am J cardiology 2005;96(suppl):5G-10G References

AHF In Critical Illness

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AHF In Critical Illness