Treatment of acute advanced heart failure

(Circ 2013;128:e240)

參考 ➡️ “I Need Help”—A mnemonic to aid timely referral in advanced heart failure

• Consider PAC if not resp to Rx, unsure re:
  • vol status,
  • HoTN,
  • hypoperfusion,
  • need inotropes
• Tailored Rx w/ PAC (qv);
  • goals of MAP >60,
  • CI >2.2 (MVO2 >60%),
  • SVR <800,
  • PCWP <18
• IV vasodilators:
  • NTG,
  • nitroprusside (risk of coronary steal if CAD)
• Inotropes (properties in addition to ↑ inotropy listed below)
• mechanical circulatory support (also see “Tailored Therapy;” JACC 2015;65:e7 & 2542)
• Cardiac transplantation:
  • ~2200/yr in U.S. <10% mort. in 1st y,
  • median survival ~13 y