Download Management of heart failure - the Helderberg Cardiac Support Group

Dr Tom Mabin
Vergelegen Mediclinic
Somerset West
Cardiac Support group
September 2016
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Poorly controlled hypertension(high blood
pressure)
Myocardial infarctions(heart attacks)
Uncontrolled Irregular heart
rhythms(arrhythmias)
Leaking heart valves
Blocked heart valves
Infections..viral
toxins:/medications eg alcohol/chemotherapy
Congenital
Unknown(cardiomyopathy)
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>10% of patients >70 years have HF
Commonest cause of hospitalisation in >70
years
Increasing frequency: ageing population; more
survivors of myocardial infarction
Most have high BP and /or heart attack history
Diagnosis often missed: treatment delayed
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Fatigue/tiredness/lack of energy
Shortness of breath
Inability to lie flat in bed at night(orthopnea)
Swelling of legs/abdomen
Blue extremities
History
 History
 History…
CAUSES:
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High blood pressure
Heart attacks/angina
Heart murmurs / valves
Heart surgery
Flu-like illnesses
Toxins/chemotherapy
CLINICAL EXAMINATION……….
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Breathless
Fast pulse
BP
fluid accumulation
 Neck veins elevated
 Ankle swelling (oedema)
 Lung congestion(crackles)
 Murmurs
 Abdominal swelling
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ECG
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Arrythmia
Heart attacks
Heart enlargement
Echocardiogram
Heart size
Heart function..left ventricular performance (ejection
fraction)
 Valve leaks and/or blockages
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Angiogram
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Coronary artery disease/ heart attckes
Ultrasound or
sonar
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LIFESTYLE CHANGES:
Restrict fluid intake: 1.5 Li/day: daily weighing
 Reduce salt intake
 Quit alcohol / cigarettes
 Reduce weight
 Regular moderate excercise
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Treat the cause:
High
BP
Coronary disease: Stents/bypass
Arrhythmia
Attend to the valve lesion if
appropriate eg surgery
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Treat the symptoms
Diuretics: remove the water
 Ace inhibitors: assist the heart
 Beta-blockers: assist the heart; slow
the pulse
 Specialised medications
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Heart failure limits a patient's ability to perform
the routine activities of daily living…
eg: lasix: puresis: spiractin
eg:prexum; pearinda;zartan;
Dilatrend; Carloc; Bilocor
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Specialised devices
Pacemakers
Artificial mechanical hearts
Heart transplant
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Postero-lateral
Increase the donkey’s (heart) efficiency