treatment of acute decompensating heart failure

(NEJM 2017;377:1964)

• Assess congestion & adequacy of perfusion

• For congestion: “LMNOP” Lasix IV; 1–2.5× usual total daily PO dose Ø clear diff between gtt vs. q12h IV Morphine (↓ sx, venodilator, ↓ afterload) Nitrates (venodilator) Oxygen ± noninvasive ventilation Position (sitting up & legs dangling over side of bed → ↓ preload)

• For low perfusion, see below

• Adjustment of home oral meds: prefer to continue, except: ACEI/ARB/ARNI: hold or ↓ dose if HoTN; ∆ to hydralazine & nitrates w/ AKI βB: hold if evidence of hypoperfusion or HoTN