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
Hemodynamic Profiles in Acute HF

Normal LV filling pressure / normal perfusion

Elevated LV filling pressure / normal perfusion

Elevated LV filling pressure / decreased

perfusion

Normal or low LV filling pressure / decreased

perfusion

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

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

ADJUVANT TREATMENT STRATEGIES IN HEART FAILURE