ACUTE HEART FAILURE

EMERGENCY REPROFUSION

• Vital part of regaining haemodynamic stability
• Primary interventions common to many etiologies
• Unstable angina/nstemi
• LVHF not associated with coronary blockage
• Stemi

Treatment for all events starts with. O2, nitrates, aspirin and beta blockers.
These simply reduce preload on the heart and slows down progression of underlying cause.

Diuretics may also be used for preload reduction. Immediate concerns with nitrates, hypotension and syncope.
Digoxin, bradycardia and hypokalemia.

DIFFERENCES

• Stemi - st elevation with MI
• nStemi - no st elevation
• Unstable angina, no st or enzymes

UA, NSTEMI

• Glycoprotein inhibs, restenosis
• Persisting symptoms, cardiac cath
• Heparinize, a partial clot will be present
• This is likely to be atherosclerotic, slow

STEMI

• Thrombolytics, within 12 hours of onset
• Why? Fibrinogen, that's why!
• Under 4 hours is best.
• Why? Necrosis happens after 4 hours
• OR pericutaneous coronary intervention

PCI

• Better prognosis
• Thrombolytics have lots of contraindications
• Emergency, may not get full history, PCI will be safer

LVHF

• Use of digoxin in non blockage
• Combo with primary intervention
• Increase ejection fraction with lowering preload

THROMBOLYTICS CONTRAINDOCATIONS

• Heammoragic stroke
• Intracranial bleeding
• Head trauma
• AORTIC DISSECTION
• Ulcer, relative risk factor

ENZYMES

• Troponin will be evident 4 hours after event
• Too late to wait for
• However, if troponin is present, this is a second event
• Troponin peaks at 12 hours, lasts approx 96 (4 days)