Acute Decompensated Heart Failure: New Strategies for Improving Outcomes -
Publication Date: May 2017 (Volume 19, Number 5)
Emily Singer Fisher, MD
Assistant Professor, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK
Boyd Burns, DO, FACEP, FAAEM
George Kaiser Foundation Chair in Emergency Medicine, Associate Professor & Program Director, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK
Sinem Sherifali, MD
Assistant Professor of Emergency Medicine, University of Florida Jacksonville, Jacksonville, FL
Scott M. Silvers, MD
Associate Professor and Chair, Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL
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.
Excerpt From This Issue
As you arrive for your ED shift, an ambulance pulls in, carrying a patient struggling to breathe. The paramedics quickly brief you: your patient is a 76-year-old woman with a history of heart failure. She has been compliant with all of her medications but has had progressively worsening, difficult breathing. You notice coarse, wet-sounding lungs with poor air movement at the lung bases. You also notice significant pitting edema in both of her legs. She describes orthopnea and states that she has been sitting up in a chair to sleep for “a while.” When you examine her medications, you note that she is on a low dose of a beta blocker and an ACE inhibitor, despite a stated history of low blood pressure. She was also prescribed spironolactone and furosemide, and you can feel an implant under the skin of her left chest wall, which she confirms as an AICD. You attach your patient to the cardiac monitor and notice she is tachycardic, with a heart rate of 115 beats/min, and her blood pressure is 80/40 mm Hg. You wonder if she would be best treated with fluids or diuretics, and your medical student asks, “How do we decide?”
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