Heart failure occurs when the heart is unable to supply output that is sufficient for the metabolic needs of the tissues, in face of acute venous return. Common causes of heart failure are hypertension, valvular heart disease, ischeamic heart disease, anaemia, and pulmonary thromboembolism.
Clinical features
Tachycardia, gallop rhythm, raised JVP, dependent oedema, tender hepatomegaly, orthopnoea, fatigue, exercise intolerance, and basal crepitations.
Common precipitating factors of heart failure in cardiac patients must be considered in treatment of acutely ill patients: poor compliance with drug therapy; increased metabolic demands, e.g., pregnancy, anaemia,; progression of underlying disease, e.g., recurrent myocardial infarction, uncontrolled hypertension; cardiac arrhythmias; pulmonary embolism; infective endocarditis; infection, e.g., pneumonia.
Investigations
- Chest x-ray: May show cardiac enlargement as well as evidence of other cardiac or pulmonary lesions.
- Heamogram-To rule out anaemia, infection
- Urea and electrolytes
- Electrocardiogram (ECG)
- Echo-cardiogram
Management-General
- Restrict physical activities.
- Order bed rest in cardiac position
- Give oxygen by mask for cyanosed patients
- Restrict salt intake, control fluid intake,and measure urine output.
- Measurement weight daily.
Management-Pharmacological
- Furosemide 40-160 mg PO OD; use higher doses in patients who were already on it.
- Digoxin 0.125-0.25mg PO OD, useful in atrial fibrillation. Loading doses for digoxin may be given to patients who are not on digoxin beginning with 0.25-0.5mg PO QDS upto a total of 1.0-1.5mg and then put on maintenance.
- Potassium supplements: Advise patients to eat fruits, e.g., bananas or oranges,
- Prophylactic anti-coagulation: Heparin 2,500 units SC BD in those patients who are on strict bed rest and marked cardiomegaly.
- Treat underlying causative factor such as hypertension and anaemia.
- If patients fail to respond to above measures consider angiotensin converting enzyme inhibitors, e.g., captopril 6.25-12.5mg PO TDS. Enalapril 2.5-10 mg PO OD/BD