Treatment Options:
| Preload Reduction *Patients with diastolic dysfunction (right MI) are often preload dependent, so use with caution | Loop diuretics Vasodilators Nitrogen – primarily venodilation Nitroprusside and BNP Analogs (nesiritide) are arterial and venous. Morphine ACEI, ARB, Aldosterone antagonists |
| Afterload Reduction | Vasodilators ACEI, ARB, Aldosterone antagonist |
| Positive Inotrope | Beta 1 agonist (dobutamine) Misc (high dose dopamine) Type 3 Phosephodiastereas inhibitor(milrinone) |
| Pulse | Beta blockers Non–DHP Calcium Channel Blockers Antiarrhythmics |
| Oxygenation and Ventilation | Non-invasive ventilation with BiPap or CPAP |
Calcium Channel Blockers worsen systolic function in systolic failure – ionotropic effects
- LVEF of 50-75 is normal
- HFpEF = heart failure with normal ejection fracture
- HFrEF = heart failure with reduced ejection fracture
Acute Decompensated Heart Failure:
- If patient is on a beta blocker, don’t use dobutamine, use milrinone.
- Nitro and diuretics cause vasodilation to improve edema.
- Continue recommended therapies while treating:
- ACEI
- Beta-blockers- do not initiate a new beta blocker until stabilized, but do not discontinue)
- Digoxin – in HF level is 0.5-2.0 – in arrhythmia, it’s 1.5-2.5 – digoxin has a narrow therapeutic index so know.
- Avoid drugs with negative ionotropy: class 1 sodium channel blocking antiarrhythmics (mexiletine, tocainide, procainamide, quinidine, disopyramide, flecainide, propafenone)