STEPUP Cardiovascular System: Acute Decompensated Heart Failure Flashcards
What is acute decompensated heart failure? What is it most commonly due to?
1) Acute dyspnea associated with elevated left-sided filling pressures, with or without pulmonary edema
2) Most commonly due to LV systolic or diastolic dysfunction
What is flash pulmonary edema?
Refers to a severe form of heart failure with rapid accumulation of fluid in the lungs
What does the differential of acute decompensated heart failure include?
1) Pulmonary embolism
2) Asthma
3) Pneumonia
All of which can cause rapid respiratory distress
What diagnostic tests can be ordered for acute decompensated heart failure?
1) ECG
2) CXR
3) ABG
4) B-type natriuretic peptide (BNP)
5) Echocardiogram
6) Possible coronary angiogram if indicated
Is hospital admission indicated for acute decompensated heart failure?
Yes
What is daily assessment of patient weight good for in acute decompensated heart failure?
Good method of documenting effective diuresis
What is the treatment for acute decompensated heart failure?
1) Oxygenation and ventilatory assistance
2) Diuretics
3) Dietary sodium restriction
4) Nitrates
5) Patients who have pulmonary edema despite use of oxygen, diuretics, and nitrates may benefit from use of inotropic agents (dobutamine)
6) There is limited evidence for use of morphine sulfate
How should oxygenation and ventilatory assistance be given in patients with acute decompensated heart failure?
Oxygenation and ventilatory assistance is given with nonrebreather face mask, NPPV, or even intubation as indicated
What is the most important intervention in treatment of acute decompensated CHF? How else does this class of medication help?
1) Diuretics are used to treat volume overload and congestive symptoms - this is the most important intervention
2) Decreases preload
Is digoxin indicated for treatment of CHF in the acute setting?
Digoxin takes several weeks to work and is not indicated in an acute setting
