0071643192.pdf

■ BNP<100 pg/dL makes heart failure unlikely.
■ BNP>500 pg/dL makes heart failure highly probable.
■ Should be compared to patient’s baseline values
■ Can be elevated in the elderly, renal failure, PE, or cor pulmonale
■ Tends to be lower in obese patients
■ Echocardiogram
■ Assesses systolic, diastolic, and valvular function

TREATMENT

■ Aggressiveness of treatment depends on severity of presentation.
■ Supportive therapy, as needed
■ Supplemental O 2
■ Noninvasive positive pressure ventilation
■ BiPAP or CPAP
■ Benefits: Oxygenation, ↓work of breathing, ↓preload and afterload
■ Nitroglycerin (NTG)
■ Sublingual, then IV if needed
■ ↓Preload by venodilation
■ ↓Afterload (at high doses) via arterial vasodilation
■ Direct coronary vasodilator (good in ischemia)
■ May not be tolerated if patient is hypotensive
■ Morphine sulfate
■ ↓Myocardial O 2 consumption by ↓catecholamines
■ ↓Preload from mild vasodilator effect
■ ↓Pain and anxiety
■ May mortality
■ Furosemide
■ For patients with evidence of fluid retention that usually develops over
days; not for use in rapid decompensation as these patients are volume
neutral or even dehydrated
■ Rapid symptom relief from venodilator effect
■ Delayed effects =↓preload and pulmonary congestion by reducing
volume
■ Nitroprusside
■ For persistent hypertension, not relieved with NTG
■ More potent arterial vasodilator than NTG, ↓afterload
■ ↓Preload via venodilator effect
■ May dilate normal coronaries more than diseased →coronary steal
syndrome
■ Nesiritide
■ For acute decompensated heart failure without cardiogenic shock
■ Antagonizes renin-aldosterone system and sympathetic nervous system →
■ Diuresis
■ ↓Preload via venodilation
■ ↓Afterload via vasodilation
■ May mortality
■ Treatment of cardiogenic shock
■ Suspect if hypotension andpoor perfusion are present
■ Correct any underlying hypovolemia firstwith judicious fluid challenge
(to maximize preload).
■ Dopamine/dobutamine
■ Both are +inotropes and +chronotropes.
■ Dobutamine may exacerbate hypotension (vasodilator effect).
■ Norepinephrine
■ If persistent hypotension despite above measures
■ →Systemic vascular resistance

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CARDIOVASCULAR EMERGENCIES

The echocardiogram is the

most helpful study to assess

cardiac function in heart

failure.

Furosemide may provide

rapid symptoms relief from

venodilator effects.

Nitroprusside may dilate

normal coronaries more than

diseased coronaries, causing

a coronary steal syndrome.

Norepinephrine will HR and

myocardial O 2 demand.

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