Acute Heart Failure Treat underlying arrhythmias, etiologies Respiratory distress? Pulmonary edema? Y Morphine IV CPAP 5-7,5 cmH2O, BiPAP if resp. acidosis Treat underlying arrhythmias, etiologies Acute Heart Failure +ACS See guidelines ACS, Consider transfer, IABP SBP > 140mmHg HyperT AHF- PULMONARY EDEMA SBP 90-140 mmHg ACUTE DECOMPENSATED HF SBP < 90mmHg+hypoperfusion CARDIOGENIC SHOCK Echocardio VASODILATORS Isosorbide dinitrate Nitroglycerine Nitroprusside (not in ACS) FLUID Challenge if possible INOTROPICS: Dobutamine, Dopamine 2-5γ Milrinone Levosimendan (not if SBP<85mmHg) Volume overload? Echocardio Y Echocardio, PAC DIURETICS: Furosemide or Bumetanide Consider IV infusion in severe overload Diuretic resistance: combination R/ or UF N N Refractory shock, hypotension? Y Good clinical response? -Consider IABP, transfer -VASOCONSTRICTORS: Dopamine>5γ or Adrenaline, Noradrenaline N Y Start PO medication