Should not be used longer than
Risk of toxicity increases with
doses. Rebound vasoconstriction may occur.
Patients on chronic home therapy
or with renal insufficiency will
May be used with sulfa allergy
Primarily inotropic, limited by
May be used with dobutamine as
May be used with dobutamine as
beta-blockers, as both have been shown to reduce patient
mortality. Of note, both of these agents are contraindicated
in patients with acute decompensation. Oral furosemide is
typically used for symptomatic relief, but no mortality
benefits have ever been demonstrated.
education regarding medication compliance, as more than half
will be readmitted for the same within the next 6 months.
Asymptomatic patients with stable vital signs and a negative
ED work-up may be safely discharged provided the precipi
tant for their presentation has been identified and adequately
addressed. Counsel these patients on the disease process and
the importance of medication and dietary compliance.
Provide appropriate discharge instructions, including r eturn
precautions, and arrange close outpatient follow-up.
The vast majority of patients with acute CHF exacerbations
require admission to a monitored unit Previously undiagnosed
Collins S, Storrow AB, Kirk JD, et al. Beyond pulmonary edema:
Diagnostic, risk stratification, and treatment challenges of
acute heart failure management in the emergency department. Ann Emerg Med. 2008;5 1 :45.
Heart Failure Society of America, Lindenfeld J, Albert NM, et al.
HFSA 2010 Comprehensive Heart Failure Practice Guideline.
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