GP Resources - HeFSSA Practitioners Program 2014 - Case 2

A patient with known HF-REF, related to burnt out sarcoidosis, with LBBB, and a history of intermittent atrial fibrillation, presents after days of deteriorating functional class into casualty with severe SOB on exertion, but comfortable at rest. This is a good case to discuss the next commonest form of AHF - deterioration in patient with known HF-REF. The pathophysiology in this case ( in contrast to case 1) is or of fluid overload and gradual neurohormonal activation. The importance of precipitating factors will be highlighted, a brief discussion of sarcoidosis and the heart, and the approach to management with higher dose diuretics, possible inotrope use, the problem of withdrawal of background therapy will be discussed. The role of devices will be discussed here together with other options to prevent recurrent hospitalisations .