Heart Failure

Acute Heart Failure Management

EMKF

Acute Heart Failure Management

  • Treatment of pulmonary edema should be focused on ‘fluid redistribution’ and not ‘fluid removal’.
  • First line: Nitroglycerin and NIV (start ASAP)
  • Second line: ACE-I (in addition or instead of NTG)
  • Third line: Diuretic like furosemide
  • Morphine has NO ROLE in modern management of cardiogenic pulmonary edema

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Acute Heart Failure and Cardiogenic Shock

EMKF

Acute Heart Failure & Cardiogenic Shock

  1. There’s minimal or no role for the administration of loop diuretics (Furosemide/Lasix) early in the management of Acute Pulmonary Edema. The majority of patients aren’t volume overloaded.
  2. Immediate care should focus on Non-Invasive Positive Pressure Ventilation and administration of nitroglycerin.
  3. In patients with End Stage Renal Disease, dialysis is what’s ultimately going to fix the patient.

 

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Acute Pulmonary Oedema…

EMKF

Key points:

1. There’s minimal or no role for the administration of loop diuretics (Lasix) early in the management of APE. The majority of patients aren’t volume overloaded.

2. Immediate care should focus on NIPPV and administration of nitroglycerin.

NOT CARDIAC: Causes of non-cardiogenic pulmonary edema

EMKF

N – near drowning…
O – oxygen therapy / post intubation pulmonary edema
T – trauma / transfusion (TRALI – transfusion-related acute lung injury)

C – CNS – neurogenic pulmonary edema
A – allergic alveolitis
R – renal failure
D – drugs
I – inhalation (toxins)
A – altitude (HAPE – high-altitude pulmonary edema),
ARDs
C – contusion