Acute heart failure

Last updated: October 27, 2022

CME informationtoggle arrow icon

  • Physicians may earn CME/MOC credit by reading information in this article to address a clinical question, and then completing a brief evaluation (see link in Tips & Links), in which they will identify their question and report the impact of any information learned on their clinical practice.
  • AMBOSS designates this Internet point-of-care activity for a maximum of 0.5 AMA PRA Category 1 Credit(s). Physicians should claim only credit commensurate with the extent of their participation in the activity.
  • MOC credit: Please review the relevant accreditation statements.
  • See “Contributor disclosures for acute heart failure” for information relating to this article.
  • For more details on our CME program and conflict of interest (COI) policy, see “AMBOSS CME information and policies.”

Acute heart failure is the rapid onset or worsening of heart failure symptoms, and it is a common cause of hospitalization in older patients. Multiple triggers can cause an acute decompensation of preexisting heart failure (ADHF) but the condition may also occur suddenly in patients with no previous history of the condition (de novo heart failure). Diagnosis is based on typical clinical features (e.g., dyspnea), laboratory findings (e.g., elevated BNP), and imaging findings (e.g., pulmonary edema). Management is often challenging because of comorbidities; most patients require admission for treatment with IV diuretics, vasodilators, adjustment of their chronic heart failure (CHF) medications, respiratory support, and careful monitoring.

Etiology of acute heart failure
Type of acute heart failure Underlying etiology [1][3]
De novo heart failure
ADHF

Consider COVID-19 infection as a potential cause in both de novo heart failure and ADHF. [6]

Clinical features of acute heart failure are commonly classified according to perfusion and the presence of congestion at rest. [1][2][5]

Classification of acute heart failure [5][7]
No evidence of congestion (∼5% of patients) Evidence of congestion (∼95% of patients)
Adequate perfusion
  • Warm and dry
  • Warm and wet
Hypoperfusion
  • Cold and dry
  • Cold and wet

The combined presence of jugular venous distention, S3 gallop, and lung crackles/rales makes a diagnosis of acute heart failure highly likely. [8]

Assess for clinical features that are suggestive of hypoperfusion (e.g., narrow pulse pressure, cool extremities, peripheral cyanosis, altered mental status, below baseline blood pressure) to identify patients with or at risk of cardiogenic shock. [2]

Approach

Diagnosis of AHF is primarily clinical; obtain natriuretic peptide if the diagnosis is uncertain.

Laboratory studies [9]

  • BNP (or NT-proBNP): useful for diagnostic confirmation and prognostication; can be measured serially to guide therapy [10][11]
    • Should always be interpreted in comparison to the patient's baseline and in the context of history, examination, and imaging.
    • High diagnostic utility in patients with an unclear diagnosis [9]
Natriuretic peptide levels in the diagnosis of heart failure [12][7][13]
Heart failure unlikely [14] Heart failure likely [14]
BNP (pg/mL)

< 100 [12]

> 500

NT-proBNP (pg/mL)

< 300 [15]

> 1000 [13]

Measuring BNP (or NT-proBNP) is especially helpful in patients with an unclear diagnosis. BNP has a high diagnostic value when combined with a physical examination and imaging.

In a patient presenting with acute dyspnea, a low BNP (or NT-proBNP) makes a diagnosis of acute heart failure very unlikely.

ECG

An ECG is indicated in all patients to assess for ACS, arrhythmias, and conduction abnormalities.

Initial imaging

All patients with suspected acute heart failure should have a chest x-ray and echocardiography performed.

Chest x-ray [5][21]

ABCDE: Alveolar edema (bat wings), Kerley B lines (interstitial edema), Cardiomegaly, Dilated prominent pulmonary vessels, and Effusions

Transthoracic echocardiogram (TTE) [5][25]

POCUS in acute heart failure

Perform a rapid assessment with bedside echocardiography and other POCUS techniques to quickly establish the underlying cause of acute dyspnea and/or shock.

Advanced imaging

If more detailed information about myocardial viability and/or perfusion is needed (e.g., procedural planning, myocardial ischemia is suspected), further imaging modalities may be necessary after the patient is stabilized. Both MRI and CT require the patient to lie flat for sustained periods and are less accurate at higher heart rates.

See also “Differential diagnoses of dyspnea.”

Wheezing can be heard in both acute heart failure and obstructive lung disease (e.g., asthma exacerbation, AECOPD). [34]

The differential diagnoses listed here are not exhaustive.

Initial management [7]

  • Perform a rapid ABCDE survey to assess hemodynamic stability.
  • Identify and treat any acute underlying cause of AHF for all patients (e.g., consider PCI for patients with ACS).

Hemodynamically stable patients

To remember the management of ADHF, think of “LMNOP”: Loop diuretics (furosemide), Modify medications, Nitrates, Oxygen if hypoxic, Position (with elevated upper body). [7][35]

For patients with ACS complicated by acute heart failure, consult cardiology for consideration of urgent coronary catheterization.

Hemodynamically unstable patients [36]

Early specialist consultation (e.g., critical care, cardiology) and admission to hospital is recommended.

Patient with a wet and cold clinical presentation have a high risk of rapid deterioration and require close hemodynamic monitoring regardless of their blood pressure. [7]

If atrial fibrillation is thought to be causing hemodynamic or respiratory instability, consider immediate electric cardioversion.

Ongoing hospital management [7]

Supportive care

Optimizing chronic therapy for CHF [2][5][7]

For patients not previously on beta blockers, use cautiously and only once the patient has been stabilized.

Monitoring [2][5]

Treatment of refractory acute heart failure [7]

Consider the following if AHF persists despite maximal respiratory and hemodynamic support.

Management depends on the classification of AHF. See “Management of cardiogenic shock” for details on therapeutic targets and monitoring.

Dry and cold AHF [7][36]

Wet and cold AHF [7][36]

Avoid inotropes in patients with left ventricular outflow tract obstruction (e.g., hypertrophic cardiomyopathy, aortic stenosis). [46]

The cornerstones of respiratory support in acute heart failure are oxygen therapy and positive pressure ventilation, typically starting with the least invasive modality and escalating as needed. [7]

Initial measures [7]

Respiratory failure [7]

EPAP and/or PEEP should be used with caution in patients with hemodynamic compromise.

Diuretic therapy in acute heart failure

Initial treatment

  • Administer diuretics intravenously, if possible.
  • Diuretic-naive patients: IV furosemide OR bumetanide [53]
  • Patients already taking diuretics: Administer 1–2.5 times the patient's usual oral dose intravenously as a bolus or continuous infusion. [35][53]

Continuing treatment

Use diuretics judiciously and assess volume status, electrolytes, and creatinine levels regularly to avoid overaggressive diuresis, as this may lead to hypotension, electrolyte imbalances, and/or a deterioration in renal function. [5][14]

Monitoring

Elevated creatinine is not a contraindication to diuretic therapy in patients with acute heart failure, as renal function typically improves with effective diuresis in cardiorenal syndrome. [5]

Vasodilator therapy in acute heart failure

Indications [5][7]

Treatment options [5]

For patients with hypertensive acute heart failure with pulmonary edema in the emergency department or prehospital setting, consider a single dose of sublingual nitroglycerine (i.e., nitroglycerine 0.4 mg sublingual once) while obtaining IV access and setting up an infusion. [35]

Cautions

  • Do not use vasodilators if SBP is < 90 mm Hg.
  • Doses should be carefully titrated to prevent large drops in blood pressure. [58]
  • Use with caution in patients with mitral or aortic stenosis. [59]

Avoid the use of vasodilators in patients with acute heart failure and hypotension.

Hyponatremia

Atrial fibrillation with RVR [60]

Consult cardiology early, as management can be complex.

Cardiorenal syndrome

Cardiorenal syndrome causes prerenal acute kidney injury with hypervolemia. Management is complex and involves early nephrology input, fluid restriction, and diuretics (see “Hemodynamic support in patients with AKI”).

Patients presenting with acute heart failure are usually initially managed in the emergency department; most require subsequent hospitalization.

Hospital admission criteria [2][8][35]

Consider admission for patients with any of the following:

Consider ICU admission for patients at high risk of deterioration, and/or patients with hemodynamic instability and/or respiratory failure requiring aggressive support. [8]

Discharge from the emergency department [2][8][35]

Discharge may be considered in selected patients with known CHF who have returned to their baseline status of health after initial management.

All patients [10][35][36][64]

Hemodynamically stable patients [10][35][36][64]

Hemodynamically unstable patients [10][35][36][64]

Interested in the newest medical research, distilled down to just one minute? Sign up for the One-Minute Telegram in “Tips and links” below.

All of the relevant financial relationships listed for the individuals below have been mitigated. For details, please review our full conflict of interest (COI) policy.

  • Alexandra Willis, copyeditor, was previously employed by OPEN Health Communications.
  1. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016; 37 (27): p.2129-2200. doi: 10.1093/eurheartj/ehw128 . | Open in Read by QxMD
  2. Long B, Koyfman A, Gottlieb M. Management of Heart Failure in the Emergency Department Setting: An Evidence-Based Review of the Literature. J Emerg Med. 2018; 55 (5): p.635-646. doi: 10.1016/j.jemermed.2018.08.002 . | Open in Read by QxMD
  3. Van Diepen S, Katz JN, Albert NM, et al. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation. 2017; 136 (16). doi: 10.1161/cir.0000000000000525 . | Open in Read by QxMD
  4. Viau DM, Sala-Mercado JA, Spranger MD, O’Leary DS, Levy PD. The pathophysiology of hypertensive acute heart failure. Heart. 2015; 101 (23): p.1861-1867. doi: 10.1136/heartjnl-2015-307461 . | Open in Read by QxMD
  5. Rimoldi SF, Yuzefpolskaya M, Allemann Y, Messerli F. Flash Pulmonary Edema. Prog Cardiovasc Dis. 2009; 52 (3): p.249-259. doi: 10.1016/j.pcad.2009.10.002 . | Open in Read by QxMD
  6. Walls R, Hockberger R, Gausche-Hill M. Rosen's Emergency Medicine. Elsevier Health Sciences ; 2018
  7. Messerli FH, Bangalore S, Makani H, et al. Flash pulmonary oedema and bilateral renal artery stenosis: the Pickering Syndrome. Eur Heart J. 2011; 32 (18): p.2231-2235. doi: 10.1093/eurheartj/ehr056 . | Open in Read by QxMD
  8. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol. 2013; 62 (16): p.e147-e239. doi: 10.1016/j.jacc.2013.05.019 . | Open in Read by QxMD
  9. Schünemann HJ, Cushman M, Burnett AE, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Advances. 2018; 2 (22): p.3198-3225. doi: 10.1182/bloodadvances.2018022954 . | Open in Read by QxMD
  10. Teerlink J, Alburikan K, Metra M, Rodgers J. Acute Decompensated Heart Failure Update. Curr Cardiol Rev. 2014; 11 (1): p.53-62. doi: 10.2174/1573403x09666131117174414 . | Open in Read by QxMD
  11. Pufulete M, Maishman R, Dabner L, et al. B-type natriuretic peptide-guided therapy for heart failure (HF): a systematic review and meta-analysis of individual participant data (IPD) and aggregate data. Syst Rev. 2018; 7 (1). doi: 10.1186/s13643-018-0776-8 . | Open in Read by QxMD
  12. Öhman J, Harjola VP, Karjalainen P, Lassus J. Focused echocardiography and lung ultrasound protocol for guiding treatment in acute heart failure.. ESC Heart Fail. 2018; 5 (1): p.120-128. doi: 10.1002/ehf2.12208 . | Open in Read by QxMD
  13. Chakaramakkil MJ, Sivathasan C. ECMO and Short-term Support for Cardiogenic Shock in Heart Failure. Curr Cardiol Rep. 2018; 20 (10). doi: 10.1007/s11886-018-1041-4 . | Open in Read by QxMD
  14. Kurmani S, Squire I. Acute Heart Failure: Definition, Classification and Epidemiology. Curr Heart Fail Rep. 2017; 14 (5): p.385-392. doi: 10.1007/s11897-017-0351-y . | Open in Read by QxMD
  15. Eisen H. Heart Failure. Springer-Verlag London ; 2017
  16. Page RL, O’Bryant CL, Cheng D, et al. Drugs That May Cause or Exacerbate Heart Failure. Circulation. 2016; 134 (6). doi: 10.1161/cir.0000000000000426 . | Open in Read by QxMD
  17. Bader F, Manla Y, Atallah B, Starling RC. Heart failure and COVID-19. Heart Fail Rev. 2020; 26 (1): p.1-10. doi: 10.1007/s10741-020-10008-2 . | Open in Read by QxMD
  18. Long B, Koyfman A, Gottlieb M. Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review. West J Emerg Med.. 2019; 20 (6): p.875-884. doi: 10.5811/westjem.2019.9.43732 . | Open in Read by QxMD
  19. Tanabe T, Rozycki HJ, Kanoh S, Rubin BK. Cardiac asthma: new insights into an old disease.. Expert Rev Respir Med. 2012; 6 (6): p.705-14. doi: 10.1586/ers.12.67 . | Open in Read by QxMD
  20. Sureka B, Bansal K, Arora A. Pulmonary edema − cardiogenic or noncardiogenic?. J of Family Med and Prim Care. 2015; 4 (2): p.290. doi: 10.4103/2249-4863.154684 . | Open in Read by QxMD
  21. Jardins TD, Burton GG. Clinical Manifestations & Assessment of Respiratory Disease E-Book. Elsevier Health Sciences ; 2019
  22. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017; 136 (6). doi: 10.1161/cir.0000000000000509 . | Open in Read by QxMD
  23. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: Executive Summary. J Am Coll Cardiol. 2013; 62 (16): p.1495-1539. doi: 10.1016/j.jacc.2013.05.020 . | Open in Read by QxMD
  24. Weintraub NL, Collins SP, Pang PS, et al. Acute Heart Failure Syndromes: Emergency Department Presentation, Treatment, and Disposition: Current Approaches and Future Aims. Circulation. 2010; 122 (19): p.1975-1996. doi: 10.1161/cir.0b013e3181f9a223 . | Open in Read by QxMD
  25. McLellan J, Heneghan CJ, Perera R, et al. B-type natriuretic peptide-guided treatment for heart failure. Cochrane Database of Systematic Reviews. 2016; 2016 (12). doi: 10.1002/14651858.cd008966.pub2 . | Open in Read by QxMD
  26. Chow SL, Maisel AS, Anand I, et al. Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association. Circulation. 2017; 135 (22). doi: 10.1161/cir.0000000000000490 . | Open in Read by QxMD
  27. Maisel A, Mueller C, Adams K, et al. State of the art: Using natriuretic peptide levels in clinical practice. Eur J Heart Fail. 2008; 10 (9): p.824-839. doi: 10.1016/j.ejheart.2008.07.014 . | Open in Read by QxMD
  28. Silvers SM, Howell JM, Kosowsky JM, Rokos IC, Jagoda AS. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Acute Heart Failure Syndromes. Ann Emerg Med. 2007; 49 (5): p.627-669. doi: 10.1016/j.annemergmed.2006.10.024 . | Open in Read by QxMD
  29. Januzzi JL, van Kimmenade R, Lainchbury J, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients. Eur Heart J. 2005; 27 (3): p.330-337. doi: 10.1093/eurheartj/ehi631 . | Open in Read by QxMD
  30. Harjola V, Parissis J, Bauersachs J, et al. Acute coronary syndromes and acute heart failure: a diagnostic dilemma and high‐risk combination. A statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2020; 22 (8): p.1298-1314. doi: 10.1002/ejhf.1831 . | Open in Read by QxMD
  31. Grote Beverborg N, van Veldhuisen DJ, van der Meer P. Anemia in Heart Failure. JACC Heart Fail. 2018; 6 (3): p.201-208. doi: 10.1016/j.jchf.2017.08.023 . | Open in Read by QxMD
  32. El Hadi H, Di Vincenzo A, Vettor R, Rossato M. Relationship between Heart Disease and Liver Disease: A Two-Way Street. Cells.. 2020; 9 (3): p.567. doi: 10.3390/cells9030567 . | Open in Read by QxMD
  33. Madias JE. Low QRS voltage and its causes. J Electrocardiol. 2008; 41 (6): p.498-500. doi: 10.1016/j.jelectrocard.2008.06.021 . | Open in Read by QxMD
  34. Gouda P, Brown P, Rowe BH, McAlister FA, Ezekowitz JA. Insights into the importance of the electrocardiogram in patients with acute heart failure. Eur J Heart Fail. 2016; 18 (8): p.1032-1040. doi: 10.1002/ejhf.561 . | Open in Read by QxMD
  35. Mueller-Lenke N. Use of chest radiography in the emergency diagnosis of acute congestive heart failure. Heart. 2006; 92 (5): p.695-696. doi: 10.1136/hrt.2005.074583 . | Open in Read by QxMD
  36. Marx JA, Hockberger RS, Walls RM et al. Rosen's Emergency Medicine - Concepts and Clinical Practice. Saunders ; 2013
  37. Natanzon A, Kronzon I. Pericardial and Pleural Effusions in Congestive Heart Failure—Anatomical, Pathophysiologic, and Clinical Considerations. Am J Med Sci. 2009; 338 (3): p.211-216. doi: 10.1097/maj.0b013e3181a3936f . | Open in Read by QxMD
  38. Broder J. Diagnostic Imaging for the Emergency Physician E-Book. Elsevier Health Sciences ; 2011
  39. Papadimitriou L, Georgiopoulou VV, Kort S, Butler J, Kalogeropoulos AP. Echocardiography in Acute Heart Failure: Current Perspectives. J Card Fail. 2016; 22 (1): p.82-94. doi: 10.1016/j.cardfail.2015.08.001 . | Open in Read by QxMD
  40. Čelutkienė J, Lainscak M, Anderson L, et al. Imaging in patients with suspected acute heart failure: timeline approach position statement on behalf of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure. 2020; 22 (2): p.181-195. doi: 10.1002/ejhf.1678 . | Open in Read by QxMD
  41. Bishu K, Redfield MM. Acute Heart Failure with Preserved Ejection Fraction: Unique Patient Characteristics and Targets for Therapy. Curr Heart Fail Rep. 2013; 10 (3): p.190-197. doi: 10.1007/s11897-013-0149-5 . | Open in Read by QxMD
  42. Pivetta E, Goffi A, Nazerian P, et al. Lung ultrasound integrated with clinical assessment for the diagnosis of acute decompensated heart failure in the emergency department: a randomized controlled trial. Eur J Heart Fail. 2019; 21 (6): p.754-766. doi: 10.1002/ejhf.1379 . | Open in Read by QxMD
  43. Russell FM, Ehrman RR, Cosby K, et al. Diagnosing Acute Heart Failure in Patients With Undifferentiated Dyspnea: A Lung and Cardiac Ultrasound (LuCUS) Protocol. Acad Emerg Med. 2015; 22 (2): p.182-191. doi: 10.1111/acem.12570 . | Open in Read by QxMD
  44. Martindale JL, Wakai A, Collins SP, et al. Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis. Acad Emerg Med. 2016; 23 (3): p.223-242. doi: 10.1111/acem.12878 . | Open in Read by QxMD
  45. Gaskamp M, Blubaugh M, McCarthy LH, Scheid DC. Can Bedside Ultrasound Inferior Vena Cava Measurements Accurately Diagnose Congestive Heart Failure in the Emergency Department? A Clin-IQ.. J Patient Cent Res Rev. 2016; 3 (4): p.230-234.
  46. Russell FM, Rutz M, Pang PS. Focused Ultrasound in the Emergency Department for Patients with Acute Heart Failure.. Card Fail Rev. 2015; 1 (2): p.83-86. doi: 10.15420/cfr.2015.1.2.83 . | Open in Read by QxMD
  47. Dietrich CF, Mathis G, Blaivas M, et al. Lung B-line artefacts and their use. J Thorac Dis.. 2016; 8 (6): p.1356-1365. doi: 10.21037/jtd.2016.04.55 . | Open in Read by QxMD
  48. Martin-Du Pan RC, Benoit R, Girardier L. The role of body position and gravity in the symptoms and treatment of various medical diseases.. Swiss Med Wkly. 2004; 134 (37-38): p.543-51.
  49. Kang MG, Kim K, Ju S, et al. Clinical efficacy of high-flow oxygen therapy through nasal cannula in patients with acute heart failure. J Thorac Dis. 2019; 11 (2): p.410-417. doi: 10.21037/jtd.2019.01.51 . | Open in Read by QxMD
  50. Zhao H, Wang H, Sun F, Lyu S, An Y. High-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy but not to noninvasive mechanical ventilation on intubation rate: a systematic review and meta-analysis. Critical Care. 2017; 21 (1): p.184. doi: 10.1186/s13054-017-1760-8 . | Open in Read by QxMD
  51. Rochwerg B, Granton D, Wang DX, et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med. 2019; 45 : p.563–572. doi: 10.1007/s00134-019-05590-5 . | Open in Read by QxMD
  52. Ferreyro BL, Angriman F, Munshi L, et al. Association of Noninvasive Oxygenation Strategies With All-Cause Mortality in Adults With Acute Hypoxemic Respiratory Failure. JAMA. 2020 . doi: 10.1001/jama.2020.9524 . | Open in Read by QxMD
  53. Masip J. Noninvasive Ventilation in Acute Heart Failure. Curr Heart Fail Rep. 2019; 16 (4): p.89-97. doi: 10.1007/s11897-019-00429-y . | Open in Read by QxMD
  54. Felker GM, Lee KL, Bull DA, et al. Diuretic Strategies in Patients with Acute Decompensated Heart Failure. N Engl J Med. 2011; 364 (9): p.797-805. doi: 10.1056/nejmoa1005419 . | Open in Read by QxMD
  55. Mullens W, Damman K, Harjola V-P, et al. The use of diuretics in heart failure with congestion - a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019; 21 (2): p.137-155. doi: 10.1002/ejhf.1369 . | Open in Read by QxMD
  56. Oh SW, Han SY. Loop Diuretics in Clinical Practice. Electrolyte Blood Press. 2015; 13 (1): p.17-21. doi: 10.5049/EBP.2015.13.1.17 . | Open in Read by QxMD
  57. Giamouzis G, Butler J, Starling RC, et al. Impact of Dopamine Infusion on Renal Function in Hospitalized Heart Failure Patients: Results of the Dopamine in Acute Decompensated Heart Failure (DAD-HF) Trial. J Card Fail. 2010; 16 (12): p.922-930. doi: 10.1016/j.cardfail.2010.07.246 . | Open in Read by QxMD
  58. Whelton, PK, Carey, RM et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension. 2017; 71 (6): p.e13–e115. doi: 10.1161/hyp.0000000000000065 . | Open in Read by QxMD
  59. Jeremias A. Cardiac Intensive Care. Elsevier Health Sciences ; 2010
  60. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63 (22): p.e57-185. doi: 10.1016/j.jacc.2014.02.536 . | Open in Read by QxMD
  61. DiMarco JP. Atrial Fibrillation and Acute Decompensated Heart Failure. Circulation: Heart Failure. 2009; 2 (1): p.72-73. doi: 10.1161/circheartfailure.108.830349 . | Open in Read by QxMD
  62. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation. 2019; 140 (2). doi: 10.1161/cir.0000000000000665 . | Open in Read by QxMD
  63. Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia. Circulation. 2016; 133 (14): p.e506–e574. doi: 10.1161/cir.0000000000000311 . | Open in Read by QxMD
  64. Rangaswami J, Bhalla V, Blair JEA, et al. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association. Circulation. 2019; 139 (16). doi: 10.1161/cir.0000000000000664 . | Open in Read by QxMD
  65. Pollard S, Edwin SB, Alaniz C. Vasopressor and Inotropic Management Of Patients With Septic Shock.. P T. 2015; 40 (7): p.438-50.
  66. Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy. Circulation. 2011; 124 (24). doi: 10.1161/cir.0b013e318223e2bd . | Open in Read by QxMD
  67. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. J Am Coll Cardiol. 2014; 64 (21): p.e1-e76. doi: 10.1016/j.jacc.2014.03.022 . | Open in Read by QxMD
  68. Ferri FF. Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1 (Ferri's Medical Solutions). Elsevier ; 2017 : p. 1779
  69. Yoo B-S. Clinical Significance of B-type Natriuretic Peptide in Heart Failure. J Lifestyle Med. 2014; 4 (1): p.34-38. doi: 10.15280/jlm.2014.4.1.34 . | Open in Read by QxMD
  70. Feenstra J, Grobbee DE, Remme WJ, Stricker BHC. Drug-induced heart failure. J Am Coll Cardiol. 1999; 33 (5): p.1152-1162. doi: 10.1016/s0735-1097(99)00006-6 . | Open in Read by QxMD
  71. Pan AM, Stiell IG, Clement CM, Acheson J, Aaron SD. Feasibility of a structured 3-minute walk test as a clinical decision tool for patients presenting to the emergency department with acute dyspnoea. Emergency Medicine Journal. 2009; 26 (4): p.278-282. doi: 10.1136/emj.2008.059774 . | Open in Read by QxMD
  72. Kuhn B, Bradley L, Dempsey T, Puro A, Adams J. Management of Mechanical Ventilation in Decompensated Heart Failure. J Cardiovasc Dev Dis. 2016; 3 (4): p.33. doi: 10.3390/jcdd3040033 . | Open in Read by QxMD
  73. Jobs A, Simon R, de Waha S, et al. Pneumonia and inflammation in acute decompensated heart failure: a registry-based analysis of 1939 patients. Eur Heart J Acute Cardiovasc Care. 2017; 7 (4): p.362-370. doi: 10.1177/2048872617700874 . | Open in Read by QxMD
  74. Čelutkienė J, Balčiūnas M, Kablučko D, Vaitkevičiūtė L, Blaščiuk J, Danila E. Challenges of Treating Acute Heart Failure in Patients with Chronic Obstructive Pulmonary Disease.. Card Fail Rev. 2017; 3 (1): p.56-61. doi: 10.15420/cfr.2016:23:2 . | Open in Read by QxMD
  75. Dunlap ME, Hauptman PJ, Amin AN, et al. Current Management of Hyponatremia in Acute Heart Failure: A Report From the Hyponatremia Registry for Patients With Euvolemic and Hypervolemic Hyponatremia (HN Registry). J Am Heart Assoc. 2017; 6 (8). doi: 10.1161/jaha.116.005261 . | Open in Read by QxMD
  76. Lee KK, Yang J, Hernandez AF, Steimle AE, Go AS. Post-discharge Follow-up Characteristics Associated With 30-Day Readmission After Heart Failure Hospitalization.. Med Care. 2016; 54 (4): p.365-72. doi: 10.1097/MLR.0000000000000492 . | Open in Read by QxMD
  77. Spicuzza L, Schisano M. High-flow nasal cannula oxygen therapy as an emerging option for respiratory failure: the present and the future. Therapeutic Advances in Chronic Disease. 2020; 11 : p.204062232092010. doi: 10.1177/2040622320920106 . | Open in Read by QxMD
  78. Mauri T, Wang Y-M, Dalla Corte F, Corcione N, Spinelli E, Pesenti A. Nasal high flow: physiology, efficacy and safety in the acute care setting, a narrative review. Open Access Emergency Medicine. 2019; Volume 11 : p.109-120. doi: 10.2147/oaem.s180197 . | Open in Read by QxMD
  79. Papazian L, Corley A, Hess D, et al. Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review. Intensive Care Med. 2016; 42 (9): p.1336-1349. doi: 10.1007/s00134-016-4277-8 . | Open in Read by QxMD
  80. Cole RT, Kalogeropoulos AP, Georgiopoulou VV, et al. Hydralazine and Isosorbide Dinitrate in Heart Failure. Circulation. 2011; 123 (21): p.2414-2422. doi: 10.1161/circulationaha.110.012781 . | Open in Read by QxMD
  81. Taylor AL, Ziesche S, Yancy C, et al. Combination of Isosorbide Dinitrate and Hydralazine in Blacks with Heart Failure. N Engl J Med. 2004; 351 (20): p.2049-2057. doi: 10.1056/nejmoa042934 . | Open in Read by QxMD
  82. Ziaeian B, Fonarow GC, Heidenreich PA. Clinical Effectiveness of Hydralazine–Isosorbide Dinitrate in African-American Patients With Heart Failure. JACC Heart Fail. 2017; 5 (9): p.632-639. doi: 10.1016/j.jchf.2017.04.008 . | Open in Read by QxMD

Access full content

Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer