# Heart Failure: Clinical Framework for Junior Doctors
> A comprehensive guide for JMOs on diagnosing and managing heart failure, including aetiology, pathophysiology, investigations, and the 4 pillars of treatment.

Tags: heart-failure, medical-education, junior-doctor-teaching, cardiology, hfref-management, clinical-framework
## Slide 1: Presenting Case
- Case: 72M with SOB, orthopnoea, PND, and bilateral leg swelling.
- Background: Hypertension and Ischaemic Heart Disease (IHD).

## Slide 2: Differentials for Acute Dyspnoea + Oedema
- Cardiac: Heart Failure, ACS, Arrhythmia (AF with RVR).
- Respiratory: Pneumonia, COPD, Pulmonary Embolism.
- Other: Renal/Liver disease, Hypoalbuminaemia.

## Slide 3: Aetiology of Heart Failure
- Causes: Ischaemic (most common), Pressure overload (HTN, AS), Volume overload (MR, AR), Myocardial disease (CM, Myocarditis), and Arrhythmias.

## Slide 4: Pathophysiology & Clinical Features
- Mechanism: Reduced Cardiac Output → RAAS Activation → Fluid Retention → Increased Preload/Afterload.
- Signs: Raised JVP, bibasal crackles, pitting oedema, S3 gallop, displaced apex beat.

## Slide 5: Investigations
- Bedside: Vitals, ECG, Fluid balance.
- Bloods: BNP/NT-proBNP (key marker), UEC, LFTs, Troponin.
- Imaging: CXR and Echocardiogram (Gold Standard for HFrEF vs HFpEF).

## Slide 6: Management – Acute & Chronic
- Acute: IV Frusemide, sitting upright, Oxygen, GTN if hypertensive.
- Chronic (4 Pillars): ACEi/ARNI, Beta-blocker, MRA, and SGLT2 Inhibitor.

## Slide 7: Triggers & Red Flags
- Triggers: Infection, ACS, medication non-compliance, NSAIDs.
- Red Flags: SBP < 90, rising creatinine, urine output < 0.5 mL/kg/hr.

## Slide 8: Case Resolution & Management Plan
- Diagnosis: Acute Decompensated Heart Failure (Ischaemic trigger).
- Plan: IV Frusemide, CXR, Echo, and Cardiology referral.

## Slide 9: Key Take-Home Points
- Echo is the gold standard.
- Always rule out ACS triggers.
- Treat fluid early with IV frusemide and fix the underlying trigger to prevent re-admission.
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