Acute Decompensated Heart Failure

Acute decompensated heart failure is a high-yield medicine shelf emergency where management depends on two key questions: Is the patient congested, and is the patient adequately perfusing?

In this episode, Chris and Mars review:

• Classic signs of pulmonary and systemic congestion
• Intravenous loop diuretics for volume overload
• Nitrates and noninvasive positive pressure ventilation in hypertensive pulmonary edema
• How to recognize cardiogenic shock
• Why norepinephrine is the preferred first-line vasopressor in hypotensive cardiogenic shock
• When to add an inotrope such as dobutamine or milrinone
• Cardiorenal syndrome and why a rising creatinine does not always mean diuresis should stop
• Common triggers for acute heart failure decompensation

Episode pearl: Congested but perfusing? Decongest. Hypotensive with end-organ hypoperfusion? Think cardiogenic shock.

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