Today in morning report the team presented a case of presumed decompensated congestive heart failure. The discussant reviewed a good approach to the diagnosis and etiology of CHF. He also talked about constrictive pericarditis and quoted an article "Undercover and Overlooked"
**You can access NEJM online for free @ the UHN. At home you can access it for free if you have a U of T library card using this link.
Regarding CHF management:
In the acute setting treatment can be loosely summarized by the nmemonic LMNOP:
L = lasix --> usually IV, dose dependent on whether they are
M = morphine --> small IV doses help with the sensation of dyspnea and can also venodilate reducing preload
N = nitrates --> as the discussant pointed out, often patients are hypertensive related to sympathetic drive. Adding nitrates will reduce preload and afterload through veno/arteriodilation
O = oxygen --> this can include Non-Invasive Positive Pressure Ventillation (NIPPV) which can be helpful in acute CHF as the positive pressure can help reduce preload as well as help overcome resistance in the lung caused by fluids
P = position --> sit the patient upright, swing their legs over the side of the bed. This will decrease preload.
The ACC has a fantastic series of pocket guidelines for many cardiac conditions. I have always liked their ACC Chronic Congestive Heart Failure Guidelines.
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