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Acute Decompensated Heart Failure

August 12, 2018 By Dr. G, PharmD

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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 ReductionVasodilators ACEI, ARB, Aldosterone antagonist
Positive InotropeBeta 1 agonist (dobutamine) Misc (high dose dopamine) Type 3 Phosephodiastereas inhibitor(milrinone)
PulseBeta blockers Non–DHP Calcium Channel Blockers Antiarrhythmics
Oxygenation and VentilationNon-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)

Filed Under: Cardiology

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020