1. 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 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