Acute Decompensated Heart Failure

Heart failure is a deadly disease that requires an understanding of the pathophysiology and diagnostic modalities to properly treat. Most HF patients will require diuresis; however, the sickest HF patients will require aggressive, focused care.

 Acute Heart Failure ED Management

Management of acute heart failure without cardiogenic shock: Oxygenation, nitroglycerin, diuresis and treating the underlying cause.

 ED Management of Heart Failure: Pearls and Pitfalls

The vast majority of patients presenting with AHF fall into the warm and wet category. Mainstay of treatment for these patients is diuresis. Start with their home dose of furosemide IV.

Acute Decompensated Heart Failure: New Strategies for Improving Outcomes

Emergency department management and appropriate interventions are discussed, along with critical decision-making points in resuscitation for both hypertensive and hypotensive patients.

Acute Heart Failure

Heart failure is a hugely common problem and when patients present in Acute Heart Failure (AHF) they can be BIG sick. It can be easy to think of the term AHF as an ultimate diagnosis, but getting upper in and a really good grip on the physiology leading to the failure of the cardiovascular system mean we can really tailor evaluation and treatment to the specific area our patients are suffering with.

Door to Furosemide (D2F) in Acute CHF…Really?

Although the authors conclude early treatment with IV loop diuretics is associated with lower in-hospital mortality, it is important to remember, patients in the early treatment group were more likely to arrive by ambulance, have an onset of symptoms that was more abrupt, and have more obvious signs of volume overload.

Episode 4: Acute Congestive Heart Failure

Nitroglycerin (NTG): Used to decrease preload (and afterload at higher doses), can be started as sublingual spray but should be switched to continuous infusion early (start at 30mcg/min, but may need to increase it by 10mcg/min every 10min, up to 150-200mcg/min – consider an arterial line for monitoring). Be cautious in preload-dependent patients such as inferior MI, pulmonary hypertension and aortic stenosis.

Morphine Associated with Mortality in Acute Decompensated Heart Failure

The use of IV morphine in ADHF is associated with increased morbidity and mortality and should be abandoned completely as a “first-line” medical therapy. If you want to decrease diastolic filling pressures in ADHF from venous pooling just use nitroglycerin.

Myths in Heart Failure: Part I – ED Evaluation

Though we see HF daily and there are several sets of guidelines available,8-12 there are several myths and misconceptions in HF evaluation and management.

Myths in Heart Failure: Part II – ED Management

A variety of misconceptions are present concerning the ED evaluation and management of AHF Patients with hypertensive pulmonary edema require nitroglycerin and NIPPV. Diuretics before these therapies can be harmful.

Podcast 675: CHF like it’s 1966

A description of recommended treatment for CHF from 1966...

POTD: Decompensated CHF - a deep dive

Today, we take a deep dive into the classification and etiology of decompensated CHF to better understand the disease process. And then a short review on the basics of management just go through it systematically.

Sympathetic Crashing Acute Pulmonary Edema (SCAPE)

To boil it down to 10 seconds: Start patient on Non-invasive ventilation with a PEEP of 6-8; quickly titrate to a PEEP of 10-15. Start the patient on a nitroglycerin drip. Administer a loading dose of 4oo mcg/min for 2 minutes (120 ml/hour on the pump for 2 minutes with the standard nitro concentration of 200 mcg/ml.) Then drop the dose to 100 mcg/min and titrate it up from there as needed. By 10 minutes, your patient should be out of the water.