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Acute Decompensated Heart Failure: New Strategies for Improving Outcomes

May 2017

Abstract

Acute decompensated heart failure is a common emergency department presentation with significant associated morbidity and mortality. Heart failure accounts for more than 1 million hospitalizations annually, with a steadily increasing incidence as our population ages. This issue reviews recent literature regarding appropriate management of emergency department presentations of acute decompensated heart failure, with special attention to newer medication options. Emergency department management and appropriate interventions are discussed, along with critical decision-making points in resuscitation for both hypertensive and hypotensive patients.

Keywords: Acute decompensated heart failure, hypertension, hypotension, reduced ejection fraction, preserved ejection fraction, myocardium, noninvasive positive-pressure ventilation, acute coronary syndromes, ACS, STEMI, COPD, dyspnea, cachexia, jugular venous distention, pulmonary edema, basilar rales, S3 gallop, Kerley B-lines, edema, cephalization, EPSS, cardiomegaly, BNP, vasodilators, nitroglycerin, clevidipine, ACE inhibitors, inotropes, nesiritide, digoxin, dopamine, dobutamine, norepinephrine, milrinone, furosemide, ECMO, AICD, levosimendan, ularitide, ultrafiltration, biomarkers, diuretics, NIPPV, emergency room, emergency department

Points

  • The patient’s airway and breathing should be stabilized with supplemental oxygen, noninvasive positive-pressure ventilation (NIPPV), or endotracheal intubation.
  • An electrocardiogram should be performed to evaluate for ischemia, strain pattern, or dysrhythmia.

Pearl

  • Perform bedside lung ultrasound to aid in the diagnosis, as it can visualize 3 or more B-lines in at least 2 zones bilaterally.
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Last Modified: 12/12/2017
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