Acute Left Ventricular Failure

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CLINICAL DESCRIPTION

Pulmonary edema due to left ventricular failure.

Note: pulmonary edema can also occur to due excessive intravenous fluid administration or massive blood transfusion or renal failure.

CLINICAL FEATURES

SIGNS AND SYMPTOMS

Dyspnea, cough {often with frothy, pink-tinged sputum}, tachypnoea, signs of increased respiratory effort and diffuse rales or crackles.

INVESTIGATIONS

  • FBC, U+E+Creatinine, RBS, Cardiac enzymes (where available), Urinalysis, HIV test, ECG, CXR, Echocardiogram

TREATMENT

General measures: Treatment objectives

  • Early recognition and treatment

NON-PHARMACOLOGICAL

  • Prop up patient to sitting position
  • Restrict fluids and salt intake
  • Active Cycle Breathing Technique

PHARMACOLOGICAL 

  • Oxygen therapy
  • Drain pleural effusions if present and huge.
  • If BP >120/80, give sublingual Nitroglycerin for pulmonary vascular dilation
  • Alternatively, Digoxin if low systolic BP and normal renal function

Adults:

  • Frusemide 40-80 mg slow IV (over 5 mins). Repeat if required
  • Intravenous Morphine 2.5mg - 5mg -10mg 

(Be cautious of patients with low blood pressure) and Metoclopramide 10mg IV

  • Repeat both if required

Alternatively:

Second Line action (refer patient to next level of care)

  • Depends on systolic blood pressure
  • Nitrates if SBP >100mmHg
  • Dopamine /Epinephrine if SBP 70- 100 mmHg and with signs and symptoms of shock

Children:

  • Give Morphine 0.1-0.2mg/kg slow IV {over 5 mins} Repeat every 4 hours if required
  • Give Frusemide 1-2mg/kg IV, PO.
  • Specific treatment should be given according to the cause e.g., hypertension