Figure 1 : The heart in acute left ventricular failure
Presentation
- Fatigue or reduced exercise tolerance
- Dilated pupils
- Dyspnoea
- Frank pulmonary oedema
- Paroxysmal nocturnal dyspnoea
- Cough
- Crepitations - after coughing
- Hypoxia & cyanosis
- Sweating
- Tachycardia
(Skills 4
nurses, 2006)
Figure 2 : Symptoms of acute LVF
Causes
- Ischemic Heart Disease / Myocardial Infarction
- Hypertension
- Aortic Stenosis
- Volume overload
- Drugs e.g. beta blockers, cocaine
- Infection (Eg: Myocarditis)
(Skills 4
nurses, 2006)
Investigations
- Blood tests to evaluate thyroid, liver, and kidney function
- Chest x-ray
- Coronary angiography
- Electrocardiogram (ECG)
- Heart stress test
- Ultrasound of the heart (echocardiogram)
(Weinrauch L. A.
& Zieve, D. 2008)
Stepwise Management
Immediate management
Morphine IV as
required.
Drug therapy
- Diuretics - Help by reducing circulatory volume and thereby reducing preload.
- Venodilators - An intravenous infusion of Glyceryl Trinitrate may be useful in reducing preload and afterload and may also improve coronary blood flow.
- Inotropic drugs - These drugs are used to increase myocardial contractility and output. They are often classified according to their activity at alpha and beta receptors.
- Dobutamine - Exerts its effects on beta1 and beta 2 receptors and thereby Increases myocardial contractility and output.
- Dopamine - Exerts its effects on dopaminergic, beta1 and beta2 receptors.
(Skills 4
nurses, 2006)
REFERENCES
Skills 4 nurses. 2006. Skills 4 nurses. [ONLINE]
Available at: http://www.skills4nurses.com/index.cgi?article+146 [Accessed 27th April 15].
Weinrauch L. A. & Zieve, D. 2008. The New
York Times. [ONLINE] Available at: http://www.nytimes.com/health/guides/disease/left-sided-heart-failure/overview.html
[Accessed 27th April 15].
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