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Slides chf jsw
- 1. 65 y/o SOBHypotensive
- 3. CHF J. Scott WietersMD FAAEM Assistant Professor Emergency Medicine Texas A&M University Health Science Center Scott and White Hospital, Temple, TX Anything but a dry topic…
- 4. Objectives “Learn you foolsbout CHF”
- 5. Epidemiology •5 million Americans •2.3%of general public •35% die in 2 yrs 80% at 6 yrs •1 million admits each year •Costs $27.9 billion •Chance to hear a CHF lecture..... •Priceless....
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- 7. Classifications? •Left v. Rightsided? •High v. Low output? •Ischemic v. Nonischemic? •Systolic v. Diastolic? •NY class I-IV?
- 9. CHF The BigPicture
- 10. Big Picture •Preload •Afterload •Renin Angiotensin •Pulmonaryedema •Cardiogenic Shock
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- 22. •Hypertensive HF 48% •Rapidly SOB •Minimal weight gain/edema •Normotensive HF 48% •Progressive Weight gain, edema, •Hypotensive HF 3% •Cardiogenic shock Initial Presentation
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- 32. I Wanagetta BNP •<100- prob not CHF •100-500 not sure what to do? •>500- probably CHF
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- 39. False Positive (falselyhigh) BNP False Negative (falsely low) BNP Left ventricular hypertrophy Obesity Ischaemia Treatment with heart failure drugs Tachycardia Hypoxaemia including pulmonary embolism Renal impairment (GFR<60 ml/ min) Sepsis COPD Diabetes Age>70 years Liver cirrhosis
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- 50. Nitrates •Stop dicking around! •Reducepreload •Afterload red. at higher doses •Nitrates better than Lasix
- 51. What Dose? • Onetablet = 80mcg/min
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- 53. Nesiritide •VMAC trial •No reductionin mortality •Just Say No... AusNn MarNn Vanquish. $279,999
- 54. Lasix •Mod/Severe helpful •Nitrates betterthan Lasix •Monotherapy? Really? •Renal Failure •NO Mortality benefit
- 55. Beta Blockers •Really no role in ADCHF
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- 59. Crashing ADCHF •Hypotensive <100? •Dopamine2-20mcg/kg/min •Dobutamine 2.5-20mcg/kg/min •Still <70? •Norepi 4 -12 mcg/min •CATH lab for IABP?
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