Heart Failure V: Medical Management

Acute decompensated heart failure requires immediate intervention.

First, position the patient in high Fowler's and continuously monitor ECG, oxygen saturation, and hemodynamic parameters such as arterial blood pressure.

Additionally, supplemental oxygen to increase PaO2 or mechanical ventilation is recommended if the patient is experiencing severe pulmonary edema.

Administer diuretics like furosemide and vasodilators, such as nitroglycerin, to reduce preload and afterload.

Morphine relieves dyspnea but needs close monitoring for respiratory depression.

Positive inotropes like dobutamine enhance myocardial contractility in patients with low cardiac output.

Next, chronic heart failure management includes supplemental oxygen to improve saturation and rest to reduce oxygen demand.

Medications such as ACE inhibitors like lisinopril and angiotensin II receptor blockers like losartan reduce afterload.

The combination of isosorbide dinitrate and hydralazine reduces preload and afterload.

Digitalis modulates neurohormonal activity, reducing renin secretion.

Diuretics like furosemide promote sodium and water excretion, reducing preload.