Management: Acute Decompensated

1. Stabilize

• Head elevation
• Respiratory support → Oxygen Delivery Devices, BiPAP (for pulmonary edema)
• Monitoring: vitals, telemetry (ECG, O2sat, RR)
• Establish IV access (edema reduces absorption)

2. ID cause (refer to ‘common cause’ section)

• !MI
• Alcohol (RF) , Cocaine, salt
• Pneumonia
• ↑High BP
• etc.

1. Medication for symptom management
   • ******** Diuretics:** reduce congestion (pulmonary edema)
   • Vasodilator: ↓ AL and PL
   • Positive Inotrope:
2. Monitoring volume status and electrolyte
   • Daily volume exams
   • Daily weights
   • Restrict salt and water
   • Replace K >4, Mg >1
3. Medication for chronic HF
   • Start guideline directed therapies: RAAi/MRA/SGLT2i/beta-blocker
4. Behavioural change and F/O plan
   • Avoid:
     • NSAID (increase Na retention)
     • CCB
   • Decrease sodium and fluid intake in diet
   • Multi-disciplinary team clinic, timely F/O within wks
     • Referral to cardiac rehabilitation
   • Weight loss
   • Exercise
   • EtOH reduction
   • Manage OSA
   • Treat iron deficiency