Heart Failure



  • NIV should be considered early in the management of heart failure.

  • NTG is an excellent single agent for hypertensive heart failure.

  • For normotensive pulmonary oedema, treatment should be focused on diuresis, supplemental oxygen and finding the precipitating cause.

  • Vasopressors and inotropes should be started for cardiogenic shock, in the setting of hypotension and signs of poor peripheral perfusion. The options include norepinephrine, dobutamine, dopamine and milrinone.


Heart Failure Cardiogenic Shock Acute Heart Failure Decompensated Heart Failure Acute Decompensated Heart Failure 
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  1. 1.
    Fang J, Mensah GA, Croft JB, Keenan NL. Heart failure-related hospitalization in the US, 1979 to 2004. J Am Coll Cardiol. 2008;52(6):428–34.CrossRefPubMedGoogle Scholar
  2. 2.
    Reddy S, Bahl A, Talwar KK. Congestive heart failure in Indians: how do we improve diagnosis & management? Indian J Med Res. 2010;132(5):549.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Gheorghiade M. Acute heart failure syndromes: current state and framework for future research. Circulation. 2005;112(25):3958–68.CrossRefPubMedGoogle Scholar
  4. 4.
    Cotter G, Felker G, Adams K, Milo-Cotter O, O’Connor C. The pathophysiology of acute heart failure—is it all about fluid accumulation? Am Heart J. 2008;155(1):9–18.CrossRefPubMedGoogle Scholar
  5. 5.
    Mahdyoon H, Klein R, Eyler W, Lakier J, Chakko S, Gheorghiade M. Radiographic pulmonary congestion in end-stage congestive heart failure. Am J Cardiol. 1989;63(9):625–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Mahajan N, Mehta Y, Rose M, Shani J, Lichstein E. Elevated troponin level is not synonymous with myocardial infarction. Int J Cardiol. 2006;111(3):442–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Silvers S, Howell J, Kosowsky J, Rokos I, Jagoda A. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute heart failure syndromes. Ann Emerg Med. 2007;49:627.CrossRefPubMedGoogle Scholar
  8. 8.
    Mattu A, Martinez J, Kelly B. Modern management of cardiogenic pulmonary edema. Emerg Med Clin North Am. 2005;23(4):1105–25.CrossRefPubMedGoogle Scholar
  9. 9.
    Allen L, O’Connor C. Management of acute decompensated heart failure. Can Med Assoc J. 2007;176(6):797–805.CrossRefGoogle Scholar
  10. 10.
    Cotter G, Metzkor E, Kaluski E, Faigenberg Z, Miller R, Simovitz A, et al. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet. 1998;351(9100):389–93.CrossRefPubMedGoogle Scholar
  11. 11.
    Fromm R, Varon J, Gibbs L. Congestive heart failure and pulmonary edema for the emergency physician. J Emerg Med. 1995;13(1):71–87.CrossRefPubMedGoogle Scholar
  12. 12.
    Levy P, Compton S, Welch R, Delgado G, Jennett A, Penugonda N, et al. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med. 2007;50(2):144–52.CrossRefPubMedGoogle Scholar
  13. 13.
    Nashed A, Allegra J. Intravenous nitroglycerin boluses in treating patients with cardiogenic pulmonary edema. Am J Emerg Med. 1995;13(5):612–3.CrossRefPubMedGoogle Scholar
  14. 14.
    Noonan P, Benet L. Incomplete and delayed bioavailability of sublingual nitroglycerin. Am J Cardiol. 1985;55(1):184–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Sacchetti A, Ramoska E, Moakes M, McDermott P, Moyer V. Effect of ED management on ICU use in acute pulmonary edema. Am J Emerg Med. 1999;17(6):571–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Sharon A, Shpirer I, Kaluski E, Moshkovitz Y, Milovanov O, Polak R, et al. High-dose intravenous isosorbide-dinitrate is safer and better than Bi-PAP ventilation combined with conventional treatment for severe pulmonary edema. J Am Coll Cardiol. 2000;36(3):832–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Peacock W, Hollander J, Diercks D, Lopatin M, Fonarow G, Emerman C. Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis. Emerg Med J. 2008;25(4):205–9.CrossRefPubMedGoogle Scholar
  18. 18.
    ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J. 2012;33:1787–847. Revista Española de Cardiología (English Edition). 2013;66(4):328.Google Scholar
  19. 19.
    Bayram M, De Luca L, Massie M, Gheorghiade M. Reassessment of dobutamine, dopamine, and milrinone in the management of acute heart failure syndromes. Am J Cardiol. 2005;96(6):47–58.CrossRefGoogle Scholar

Copyright information

© Springer India 2016

Authors and Affiliations

  1. 1.Department of Emergency MedicineApollo Health CityHyderabadIndia

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