HypotensiveAcute Heart Failure Syndrome Javier Benitez (@jvrbntz) In 5 slides or less
Case Presentation● 73 yo man w Hx of CHF, HTN, MI presents withworsening SOB x 2 days. VS: HR 105 BP 88/64 RR 23O2sat 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, yourworking diagnosis is acute CHF. ● What would you do next?
Labs l Images l Therapy l Dispo●Labs: Cardiac markers, CBC, BMP, BNP (for theadmitting team), BUN, Cr● Images: CXR, ECG, bedside ECHO●Therapy: Acute heart failure syndrome may bebroadly divided into 3 categories:Hypertensive, Normotensive, Hypotensive
Hypotensive Acute Heart Failure Syndrome●Low SBP should be looked at carefully as it may be atbaseline. Look at the pt look at the BP and correlate●In case of hypoperfusion or cardiogenic shock considergiving 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
ReferenceAcute Heart Failure Syndromes; InitialManagement; Peter S. Pang, M.D. Emerg Med Clin North Am. 2011 Nov;29(4):675-88, v.