Acute Heart Failure

AHF may present as a first occurrence (de novo) or, more frequently, as a consequence of acute decompensation of chronic HF, and may be caused by primary cardiac dysfunction or precipitated by extrinsic factors, often in patients with chronic HF - Rob & James Simon

Acute Heart Failure

image by: Heart Failure Aware

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Acute Decompensated CHF with Michelle Perkins

It is critical to remember that the traditional teaching that patients in CHF are fluid-overloaded is not accurate for this situation. They are fluid-overloaded in their lungs but not total body... what you need to do is treat with nitroglycerin first. Also, non-invasive positive pressure ventilation (NIPPV) is key.

The combination will reduce preload, reduce afterload, and help with LV dysfunction in such patients. Decreasing preload will decrease RV output to an amount that the LV can handle which improves the fluid backup. Decreasing afterload also improves LV output. All of this has helped reduce the need for intubation in these sick patients... When it comes to nitrates, the…

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 Acute Decompensated CHF with Michelle Perkins

Acutely decompensated CHF can be a highly dangerous condition and one that needs immediate management.

BC Emergency Medicine Network

Treatment Principles (Acute and Chronic): Preload reduction: Diuretics, Nitroglycerin, Restrict fluid/sodium. Afterload reduction: ACE-I, Nitroglycerin, Intra-aortic Balloon Pump (IABP). Increase contractility: Milrinone, Dobutamine, Ventricular Assist Device (VAD). Decrease myocardial work: Beta-blockers, Ivabradine, IABP, VAD. Increase coronary perfusion: Stents, CABG, IABP.

Core EM

Consider Non-invasive Positive Pressure Ventilation (NIPPV) in setting of respiratory distress, hypercapnia or persistent hypoxia despite supplemental O2.


Assume valvular problem in new-onset CHF. Assume valve thrombosis in CHF with a prosthetic valve. Do not give vasodilators in aortic stenosis, HOCM; yes in mitral regurgitation.

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