← Diagnosis and Management Guides
Acute Heart Failure
Key considerations: Cardiogenic shock, Acute MI causing CHF, Valvular emergency
Cannot miss
- Cardiogenic shock
- Acute MI causing CHF
- Valvular emergency
- Pericardial tamponade
Likely diagnoses
- Decompensated HFrEF
- Diastolic heart failure
- Volume overload from non-compliance
Red flags
- Hypotension
- Severe respiratory distress
- Cold extremities
- New murmur
Workup
- history: Orthopnea, PND, weight gain, dietary/med non-compliance; exam: JVD, crackles, S3 gallop, peripheral edema, hepatojugular reflux; labs: BNP/NT-proBNP, troponin, BMP, CBC, LFTs; imaging: CXR: cephalization, Kerley B lines, effusions; Echo; bedside: Lung ultrasound (B-lines), IVC assessment
Management
- immediate: IV furosemide (double home dose or 40mg if new); Nitroglycerin drip if HTN; BiPAP/CPAP for respiratory distress; general: Strict I&O, daily weights, sodium restriction; Optimize GDMT: ACEi/ARNI, beta-blocker, MRA, SGLT2i
Disposition
- admit: All acute decompensated HF requiring IV diuretics; discharge: After diuresis to dry weight with optimized meds; consults: Cardiology, consider advanced HF if refractory
Clinical pearls
- Lung ultrasound B-lines are more sensitive than CXR for pulmonary edema
- Cold and wet = worst phenotype — may need inotropes
Source and review
- AHA/ACC HF Guidelines 2022. Last reviewed: 2024-11-01