Heart Failure

Written By Craig D

Acute heart failure (HF) generally starts with increasing shortness of breath (SOB); The UK National Heart Failure Audit reports almost 80 % of those admitted for their first hospitalization with acute or decompensated HF present with SOB on at least moderate exercise. This is lower in subsequent hospitalizations. (source; this may be a difficult read for some, as you will have to translate it from British.)

This is sometimes accompanied by non-specific signs and symptoms of edema, fatigue, loss of appetite and changes in weight.

 

Look for S/Sx of HF across different systems/areas, such as:

Respiratory:

  • Rate

  • Severity of dyspnea; how limiting are their Sx

  • SOB/DOE; how hard they are working to breathe

  • screen for orthopnea (tolerance of lying prone), effort of breathing, oxygen saturation, and a timeline of progression

Hemodynamic:

  • BP trend/monitoring

Rhythm abnormalities:

  • Screen for heart rhythm abnormalities; signs, Sx, Hx.

Cardiac Output:

  • Peripheral perfusion

  • Urine output

  • Mental status

Signs of Congestion:

  • Rales

  • peripheral edema

  • Jugular venous pressure (JVP)

Testing:

  • Hemogram

  • Nuclear Blood Study

  • BMP for renal functions and electrolytes

  • Troponin

  • NT-proBNP (natriuretic peptide level)

Anxiety

  • Is one I often forget to count.

 
 

Fluid Restrictions

2000mL = 67.6 oz = 8.5 cups

1800mL = 60.9 oz = 7.6 cups

1600mL = 54.1 oz = 6.8 cups

1500mL = 50.7 oz = 6.3 cups

1400mL = 47.3 oz = 5.9 cups

1200mL = 40.6 oz = 5.1 cups

1100mL = 37.2 oz = 4.6 cups

1000mL = 33.8 oz = 4.2 cups

 

Compression Stockings

10 -15 mmHg “Soft” - OTC; no Rx needed

15-20 mmHg “Soft” - OTC; no Rx needed

20-30 mmHg “Medium” - Rx needed

30-40 mmHg “Hard” - Rx needed

Patients can get these at:

  • Aspirus Home Medical

  • Pink Ribbon in Wausau

 

HF Education Sites

Recommended HF website for patient education: (link)

NIH StatPearls on HF: (link)

Craig D