Acute Left Ventricular Failure

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

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 2.5 mg -5-10mg (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