• Heart failure
    • Usually present to ITU with pulmonary oedema or cardiogenic shock with associated renal, liver, cerebral dysfunction
    • As CCF progresses, pts often have a decline in renal function (cardio-renal failure)
      • 50% 4 year mortality, 12x higher mortality if present in vascular patients
    • Ix
      • CXR, ECG, echo, FBC, U&E, TnT, Bnp, coronary angiography
    • Monitoring
      • ECG, SpO₂, BP, art line, temp, CVP measurement to estimate RV filling and mixed venous O₂ saturation.
      • PAC may be indicated in LVF as RA filling pressure may not correlate well with L sided pressures. TOE and TTE may be used in experienced hands
    • Aetiology
      • IHD, HT, DM, valvular disease, CM
      • Mechanism is due to myocyte dysfunction or death and longstanding pressure or volume overload
      • EF <35% is a strong predictor of outcome
    • Chronic treatments
      • ACE(I)
      • β-blockers
      • Spironolactone
      • ARBs
      • Digitalis
      • Hydralazine/nitrates
    • Treatment
      • Oxygenation
        • CPAP or NIPPV may be needed
      • Haemodynamic support
        • Reduce preload
          • Loop diuretic
          • Thiazides
        • Optimise afterload
          • Nitrates
          • Hydralazine (PO)
          • Recombinant BNP
          • β-blocker
        • Inotropes
          • Dopamine
          • Dobutamine
          • Noradrenaline
          • Levosimendan
          • Adrenaline
          • Enoximone/milrinone
      • Mechanical
        • IABP
        • Biventricular pacing
        • LVAD
        • ICD
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/8/5/161.full.pdf
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/8/5/167.full.pdf

    • Link:www.nice.org.uk/nicemedia/live/13099/50526/50526.pdf