Documente Academic
Documente Profesional
Documente Cultură
1. flow
2. fluid HISTORY
3. filter. See dyspnoea guidelines for evidence-based
differential diagnoses.
Flow dyspnoea
worsening cough
The ability of the heart to eject the blood delivered to (productive of white
it depends on three factors: sputum)
1. the amount of blood returning to the heart (preload) pink frothy sputum
Symptoms: waking at night gasping
2. the co-ordinated contraction of the myocardium for breath
3. the resistance against which it pumps (afterload). breathlessness on lying
down (sleeping on more
Pre-load may be increased by over-infusion of IV fluid pillows recently?)
or fluid retention associated with renal failure. Co- anxious / restless.
ordinated contraction fails following heart muscle
damage (myocardial infarction (MI), heart failure) or ankle oedema
Symptoms of MI may
due to arrhythmias. After-load increases with chest pain
be associated with:
hypertension, atherosclerosis, aortic valve stenosis or worsening of angina.
peripheral vasoconstriction.
admissions for heart
failure, fluid on
legs/lungs
Fluid
previous MI / angina /
Previous history:
The blood passing through the lungs must have angioplasty /coronary
enough oncotic pressure to hold on to the fluid artery bypass grafting
portion as it passes through the pulmonary capillaries. diabetes
As albumin is a key determinant of oncotic pressure, hypertension.
low albumin states lead to pulmonary oedema, e.g.
home oxygen
burns, liver failure, nephrotic syndrome. Specific Treatment Options
ACE inhibitors
Current medication: beta-blockers
diuretics
Filter
anti-arrhythmic drugs.
The capillaries through which the fluid passes may
increase in permeability, e.g., acute lung injury (as in smoking
smoke inhalation), pneumonia or drowning. Other risk factors family history
for heart disease: high cholesterol
The commonest cause of pulmonary oedema diabetes.
presenting to UK Ambulance Services is secondary to
acute heart failure.1
The overall prevalence of heart failure varies between
1-2%, varying with age. 80% of these people will be
diagnosed following acute admission to hospital.1
Approximately 30% will be re-admitted to hospital
each year.2
heart strain Sit the patient upright / prop the trolley up.