ACUTE HEART FAILURE

(Acute Decompensated HF)

Epidemiology
40% to 50% of patients hospitalized
have HFpEF.
disproportionally affects elderly
people, with a mean age of 75 years
affects men and women almost
equally,
Hypertension is the most prevalent
of the concurrent conditions

Pathophysiology

Evaluation of the Patient w/ AHF

(1) establishing a definitive diagnosis of AHF as
rapidly and efficiently as possible;
(2) emergent treatment for potentially lifethreatening conditions (e.g., shock, respiratory
failure)
(3) identifying and addressing any relevant
clinical triggers,
(4) risk stratification for triage of the patient to
an appropriate level of care;
(5) defining the clinical profile of the patient

Goals of Management
1. Stabilize hemodynamic derangements
2. Identify and treat reversible
precipitating factors
3. Prevent disease progression and relapse

Pharmacotherapy of Acute HF
VASODILATORS
Nitroglycerin
Nitroprusside
Nesiritide

Arterial and venodilatation

Dec LV filling pressure, dec MR, inc CO

Pharmacotherapy of Acute HF
INOTROPES
Dobutamine
Milrinone
Levosimendan

Stimulate cardiac contractility, peripheral

vasodilation

Dec LV filling pressure, Inc CO

Pharmacotherapy of Acute HF
VASOCONSTRICTORS
Dopamine
Epinephrine
Phenylephrine
Vasopressin

Support systemic BP

Hemodynamic Profiles in Acute HF

MECHANICAL and SURGICAL

INTERVENTION in ACUTE HF
Intraaortic balloon pump (IABP)
Left ventricular assist device (LVAD)
Cardiac transplantation

LVAD

PLANNING FOR HOSPITAL DISCHARGE

Patient education
Criteria for discharge:
At least 24H of stable fluid status, BP , and
renal function on the planned home oral
regimen
Free of dyspnea or symptomatic hypotension
while at rest or on ordinary activity

ADJUVANT TREATMENT STRATEGIES IN

HEART FAILURE
Treatment
Anticoagulation

Anti-arrhthymic
drugs

Indications

Comments

Atrial fibrillation
Warfarin preferred, or
Any embolic event,
heparin for bed-bound pxs
regardless of
Aspirin is a reasonable
rhythm
alternative if full antiImmobilization in
coagulation is contrabed
indicated for other reasons
Atrial fibrillation
Digoxin effectively controls
the ventricular rate in AF

ADJUVANT TREATMENT STRATEGIES

IN HEART FAILURE
Treatment
Comments
Anti-arrhythmic

Indications

Ventricular
tachycardia

Other antiarrhythmic

Amiodarone is also
usually DOC

Life threatening
arrhythmias not resp
to drugs

Surgical ablation,
ICD