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Course Image Left sided Heart Failure

Left sided Heart Failure

ACE
Cardiovascular Dynamics

Summary

Acute heart failure (AHF) represents a diverse spectrum of clinical presentations resulting from an array of acute and chronic pathologies that compromise cardiac function. It can present de novo or, more commonly, as a decompensation of pre-existing chronic heart failure.  Presentations can range from a normotensive patient with breathlessness and fluid retention to one with florid cardiogenic shock.



General Information

Enrolled trainees 2412

Open 15.07.2019

Available for ESICM members

Student effort 3

Last Updated August 29, 2022

Intended Learning Outcomes

After completing this module, the student should be able to:

  • Describe the epidemiology and the importance of heart failure within intensive care medicine.
  • Describe the pathophysiological responses of the failing heart, specifically the neurohormonal response and how these impact on the left ventricular pressure-volume loop.
  • Classify the diverse causes of acute decompensated heart failure.
  • Discuss the workup for a patient with acute heart failure describing the key features of clinical assessment and investigations.
  • Outline the place for grading systems, prognostication and scoring systems for the patient with acute heart failure and their limitations.
  • Outline the basic and advanced monitoring available for the critically unwell patient with acute heart failure including cardiac output monitoring.
  • Describe the management of heart failure as outlined within the European Society of Cardiology Guidelines.
  • Outline the physiological targets and standard organ support when treating the patient with acute heart failure.
  • Describe the indications and timing for short term mechanical circulatory support in acute heart failure.
  • Outline the haemodynamic goals and effects of mechanical circulatory support
  • Describe the key characteristics of specific devices including, intra-aortic balloon pump (IABP), Impella, TandemHeart, Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO).
  • Discuss the role of long term mechanical circulatory support and heart transplantation.

Relevant competencies in CoBaTrICE

  • 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology
  • 1.3 Manages the patient post-resuscitation
  • 2.2 Undertakes timely and appropriate investigations
  • 2.3a Performs and interprets focused transthoracic echocardiography
  • 2.4 Performs electrocardiography (ECG / EKG) and interprets the results
  • 2.9 Monitors and responds to trends in physiological variables
  • 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis
  • 3.1 Manages the care of the critically ill patient with specific acute medical conditions
  • 3.2 Identifies the implications of chronic and co-morbid disease in the acutely ill patient
  • 3.3 Recognises and manages the patient with circulatory failure
  • 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation
  • 4.5 Describes the use of mechanical assist devices to support the circulation
  • 5.17 Demonstrates a method for measuring cardiac output and derived haemodynamic variables

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