0071643192.pdf

■ BP and coronary perfusion pressure

■ Will HR and myocardial O 2 demand

■ Intra-aortic balloon pump as bridge to revascularization or valvular repair

(contraindicated in acute aortic regurgitation)

■ Treat any precipitating events

■ Blood pressure control

■ Correct dysrhythmias (rate control or conversion)

■ Treat infection, ischemia, etc.

■ Avoid

■ Nitrates in patients taking erectile dysfunction drugs.

■ Nitrates in severe aortic stenosis, RV infarct, and diastolic dysfunction

(need preload!)

■ Excessive diuresis in patients with acute pulmonary edema or preload

dependent states (may actually need the intravascular volume)

Table 2.11 summarizes the medications for decompensated heart failure and

pulmonary edema.

COMPLICATIONS

■ Dysrhythmias and sudden death

■ Intracardiac thrombus and embolism

■ Progression of disease

Stable Chronic Heart Failure

SYMPTOMS

■ The New York Heart Association (NYHA) classifies heart failure based on

severity of symptoms (see Table 2.12). These classifications have prognostic

and treatment implications.

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CARDIOVASCULAR EMERGENCIES

TABLE 2.11. Medications for Decompensated Heart Failure and Pulmonary Edema

MEDICATION BENEFICIALEFFECTS DELETERIOUSEFFECTS

Nitroglycerin ↓Preload Severe hypotension with:

↓Afterload (high doses) Viagra use

Coronary vasodilation Aortic stenosis

Hypertrophic cardiomyopathy

RV infarct

Morphine ↓Catecholamines CNS and respiratory depression

↓Preload (mild)

↓Anxiety, pain

Furosemide Immediate venodilator Hypotension from hypovolemia

effect (↓preload) Hypokalemia

Delayed diuresis

Nitroprusside ↓Afterload Coronary steal

↓Preload Hypotension

Coronary vasodilation

Nesiritide Diuresis Hypotension

↓Preload Renal failure

↓Afterload ?Increased mortality

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