21 Acute Heart Failure	171

Immediate symptomatic treatment

	Anxious, pain, distress	Yes	Analgesia—morphine, fentanyl,
			sedation

Pulmonary congestion	Yes	Diuretic /vasodilator/vasopressors

Increase FiO2, Arterial oxygen saturation <95% Yes CPAP, NIPPV, invasive

Mechanical ventilation

	Arrhythmia	Yes	Pacing, antiarrhythmics,
			Cardioversion

Fig. 21.2 Stepwise medical management of the patient presenting heart failure

Suggested Reading

1.NICE. Chronic heart failure. National clinical guidelines for diagnosis and management in primary and secondary care. The national collaborating centre for chronic conditions. London: NICE; 2005;5:p. 1–163.

2.McCullough PA, Nowak RM, McCord J, et al. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) multinational. Circulation. 2002;106:416–22.

The evaluation of acute dyspnea would be improved with the addition of BNP testing to clinical judgment in the emergency department.

3.Lindenfeld J, Albert NM, et al. Heart Failure Society of America, HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010;16(6):e1–2.

4.Hunt SA, Abraham WT. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119(14):e391–479.

5.Dickstein K, Cohen-Solal A, Filippatos G. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008;29(19):2388.