Acute Decompensated Heart Failure

Episode overview

Acute decompensated heart failure is a high-yield medicine shelf emergency where management depends on two key questions: is the patient congested, and is the patient adequately perfusing? In this episode, Chris and Mars review classic signs of pulmonary and systemic congestion, intravenous loop diuretics for volume overload, nitrates and noninvasive positive pressure ventilation in hypertensive pulmonary edema, how to recognize cardiogenic shock, why norepinephrine is the preferred first-line vasopressor in hypotensive cardiogenic shock, when to add an inotrope such as dobutamine or milrinone, cardiorenal syndrome and why a rising creatinine does not always mean diuresis should stop, and common triggers for acute heart failure decompensation. Episode pearl: Congested but perfusing? Decongest. Hypotensive with end-organ hypoperfusion? Think cardiogenic shock.