X hits on this document

PDF document

PHARMACOLOGICAL TREATMENT OF HEART FAILURE (HF) - page 48 / 48

90 views

0 shares

0 downloads

0 comments

48 / 48

Nitrates should be administered for patients with pulmonary congestion unless the systolic blood pressure is less than 100 mm Hg or more than 30 mm Hg below baseline. Patients with pulmonary congestion and marginal or low blood pressure often need circulatory support with inotropic and vasopressor agents and/or intra- aortic balloon counterpulsation to relieve pulmonary congestion and maintain adequate perfusion. (Level of Evidence: C)

A diuretic (low- to intermediate-dose furosemide, or torsemide or bumetanide) should be administered to patients with pulmonary congestion if there is associated volume overload. Caution is advised for patients who have not received volume expansion. (Level of Evidence: C)

Beta-blockade should be initiated before discharge for secondary prevention. For those who remain in heart failure throughout the hospitalization, low doses should be initiated, with gradual titration on an outpatient basis. (Level of Evidence: B)

Long-term aldosterone blockade should be prescribed for post-STEMI patients without significant renal dysfunction (creatinine should be less than or equal to 2.5 mg/dL in men and less than or equal to 2.0 mg/dL in women) or hyperkalemia (potassium should be less than or equal to 5.0 mEq/L) who are already receiving therapeutic doses of an ACE inhibitor, have an LVEF of less than or equal to 0.40, and have either symptomatic heart failure or diabetes. (Level of Evidence: A)

Echocardiography should be performed urgently to estimate LV and RV function and to exclude a mechanical complication. (Level of Evidence: C)

Class III

Beta-blockers or calcium channel blockers should not be administered acutely to STEMI patients with frank cardiac failure evidenced by pulmonary congestion or signs of a low-output state. (Level of Evidence: B)

Document info
Document views90
Page views90
Page last viewedSat Dec 03 11:35:57 UTC 2016
Pages48
Paragraphs486
Words17904

Comments