Brief description on management of hypotensive acute heart failure syndrome.

1. Hypotensive
Acute Heart Failure Syndrome
Javier Benitez (@jvrbntz)
In 5 slides or less

2. Case Presentation
●
73 yo man w Hx of CHF, HTN, MI presents with
worsening SOB x 2 days. VS: HR 105 BP 88/64 RR 23
O2sat 94% Temp 98.7 PE: JVD, cold clammy skin
●
The patient is placed on oxygen via NC, BP monitor,
ECG monitor, pulse oximeter, head of the bed 45o
●
He is in mild discomfort, after Hx and PE, your
working diagnosis is acute CHF.
●
What would you do next?

3. Labs l Images l Therapy l Dispo
●Labs:
Cardiac markers, CBC, BMP, BNP (for the
admitting team), BUN, Cr
● Images:
CXR, ECG, bedside ECHO
●Therapy:
Acute heart failure syndrome may be
broadly divided into 3 categories:
Hypertensive, Normotensive, Hypotensive

4. Hypotensive
Acute Heart Failure Syndrome
●Low SBP should be looked at carefully as it may be at
baseline. Look at the pt look at the BP and correlate
●In case of hypoperfusion or cardiogenic shock consider
giving fluids and using inotropes such as dopamine,
dobutamine, and milrinone.
● If pulmonary edema develops:
consider IV vasodilators, furosemide
● Cardiology consult
● Dispo: ICU or telemetry depending on severity

5. Reference
Acute Heart Failure Syndromes; Initial
Management; Peter S. Pang, M.D.
Emerg Med Clin North Am. 2011 Nov;29(4):675-88, v.