Left Heart Failure
LV failure spans a spectrum of severity which ranges from mild heart failure decompensation to frank cardiogenic shock - Josh Farkas
HWN Suggests
Left Heart Failure
Management Options:
- Decrease Pre-load: Salt and water restriction, reduce caffeine, alcohol and smoking, diuretics - get euvolemia, then titrate to lowest possible dose.
- Improve contractility: Inotropes
- Reduce afterload: Vasodilators
- Improve Mortality: ACE inhibitors eg. ramipril - NNT 26. Titrate up, Angiotensin receptor blockers if ACE intolerant, Beta blockers eg. metoprolol, Consider aldosterone agonists like spironolactone NNT 10 or eplerenone NNT.
Articles of Interest
Left heart failure: A review of clinical status and meta-analysis of diagnosis and clinical management methods
Left heart failure (LHF) is a complex syndrome affecting cardiac function and/or structure with significant morbidity and mortality. LHF has had extensive research on epidemiology, clinical manifestation, diagnosis and clinical management but most of the early research did not distinguish LHF from other forms of heart failure such as right ventricular and bi-ventricular failure.
Cardiogenic shock & severe LV failure
LV failure spans a spectrum of severity which ranges from mild heart failure decompensation to frank cardiogenic shock.
How to Manage Emergency Department Patients with Left Ventricular Assist Devices
LVAD patients should immediately be assessed for signs of poor perfusion and volume resuscitated as appropriate. Auscultate for a precordial/epigastric “hum”—absence of this indicates pump failure.2 LVAD patients are supported and followed longitudinally by a multidisciplinary team. Early involvement of a patient’s LVAD coordinator should be considered once a patient has been stabilized.
Left Ventricular Assist Device
Always contact the closest VAD coordinator or cardiac transplant center as soon as possible. Hypotension can be a non-specific finding with VADs but always look for other etiologies. VADs are preload dependent.
Pathway Medicine
In developed countries, Ischemic Heart Disease and hypertension likely contribute to the most cases
The Pulmonary Manifestations of Left Heart Failure
1 Unfortunately, despite the considerable progress that has been made in understanding the pathophysiology of pulmonary edema, the pulmonary complications of this condition continue to challenge the bedside clinician.
Resources
StatPearls
The most common etiologies of left heart failure are coronary artery disease and hypertension. The latter can cause left heart failure through left ventricular hypertrophy...
