#SimBlog: Acute Heart Failure

““69-year-old female. Awoke short of breath 6 hours ago. No chest pain.””

— Pmh/ Hypertension Meds/ Lisinopril, Furosemide, NKDA

Observations

A – Patent

B – Sats 88% (21%), RR 35

C – HR 135, BP 175/86

D – Alert

E – Pyrexial

Clinical Findings

• Bilateral Crackles to the mid zones

• Pitting Oedema

• Raised JVP

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Why We Simulated?

Difficulty in breathing is a frequent presentation to the ED, but can have a wide differential.

Acute heart failure is common with over 67,000 admissions in England and Wales per year (Dworzynski, Roberts, Dudman, Mant 2014) [1].

It is important to recognise the clinical features and the radiological appearance, as the differential for a patient with dyspnoea can be quite broad.

Appropriate management in the ED can make a significant difference to these patients. The current NICE guidelines do not recommend the use of opiates or the routine use of nitrites (IV nitrates are for use in specific circumstances and should warrant level 2 care).

It is therefore important to involve cardiology, outreach, or even critical care to support these patients on the wards. The NICE guidelines recommend that all patients admitted with heart failure should be managed by cardiology or have input from a Heart Failure Outreach team.

Don't forget to ask: why has your patient developed acute heart failure/pulmonary oedema? Has your patient had an acute coronary event?

Learning Points

1. Indications for CPAP

2. Task overload and feedback 

3. CPAP circuit location

Positive Feedback

• Roles Assigned

• Mental Modelling

• Re-assured the patient

References:

1. Katharina Dworzynski, Emmert Roberts, Andrew Ludman, Jonathan Mant, 2014, Diagnosing and managing acute heart failure in adults: summary of NICE guidance British Medical Journal, 2014;349:g5695

Further Reading:

• NICE: Acute heart failure – diagnosing and managing acute heart failure in adults.

Edit & Peer Review by Rebecca Prest