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Author: Admin | 2025-04-28
Up to 2.5x dose.If lasix 40mg po QD, then lasix 40-100mg IVOxygenCPAP/BiPAPIncreases intrathoracic pressure and thus reduces preloadACEIAfterload reductionEnalaprilat at 0.004mg/kg as IVB or 1mg drip over 2hrAvoid in pregnancy, hyperK+, angioedemaDigoxinDecompensated HFDigoxin and Amiodarone are the only medications indicated for use in decompensated HF for rate control if needed[9]Evidence suggests that treating rate in acutely ill patients including CHF leads to worse outcomes[10]Compensated HF (not acutely symptomatic from failure)May benefit from a fib rate control, but calcium-channel blockers and beta-blockers first line, goal of Diltiazem low and slow at 5mg/hrAVOID in severe heart failure, preexcitation syndromeAVOID in significant hypotensionMetoprolol 2.5 - 5.0mg over 2 min, then q5 as needed to max of 15mgEsmolol 0.5mg/kg bolus over 1 min, then 50 mcg/kg/min, may increase q30 min by 50 mcg/kg/minMedications to AvoidAnti-dysrhythmics other than digoxin and amiodaroneCalcium-channel blockers - worsen HFNSAIDs - sodium retention, worsen toxicity of diuretics and ACE-IThiazolidinediones - worsen HFMorphine - chart reviews show increased morbidity in ADHF patients[11][12]DispositionAdmission CriteriaCCORT - Emergent Heart Failure Mortality Risk Grade Calculator7 day mortality risk score calculator for patients presenting to the ED with decompensated HFhttps://ehmrg.ices.on.caAHCPR '00ACSPulmonary edema/respiratory distressO2 sat Severe complicating illnessCHF refractory to outpatient therapyAnasarcaSymptomatic hypotension or syncopeArrhythmia (e.g. new a. fib)Inadequate outpatient supportCHF Drug Target DosesACE inhibitorLisinopril 5mg QD start; 20mg QD goalCaptopril 25mg tid start; 100mg tid goalBenazepril 10mg QD start; 40mg QD goalARBLosartan 25mg BID start; 50mg BID goalValsartan 80mg QD start; 160mg QD goalBeta-blockerCarvedilol 3.125mg BID start; 25mg BID goal (50mg BID goal if weight > 85 kg)Metoprolol ER 12.5mg QD start; 190mg QD goalOthersHydralazine/isosorbid dinitrate 10-20mg (1 tab) tid start; 100-80mg (5 tabs) goal for black patients with NYHA III-IV already on BB and ACEiSpironolactone 25mg QD start; 50mg QD goal for indications:LVEF LVEF LVEF See AlsoPulmonary EdemaCHF MedsExternal LinksMDCalc - Emergency Heart Failure Mortality
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