Severe Heart Failure & Cardiogenic Shock - Management ...
2.1K
Description

Severe Heart Failure & Cardiogenic Shock - Management Checklist 
Evaluation 
 - EKG & echocardiography 
 - CBC, Lytes including Ca/Mg/Phos 
 - Troponin, Lactate, Liver function tests if shock is suspected 
 - TSH and/or digoxin level depending on context 
Rx 1 — Treat the lungs 
 - Consider BiPAP (vS intubation) in cardiogenic pulmonary edema 
 - Large effusion(s) may be drained if causing acute distress 
 - Consider inhaled epoprostenol for intubated patient with right ventricular failure or pulmonary hypertension 
Rx 2 — Optimize the MAP 
 - HTN/normotension Afterload reduction (nitroglycerine infusion or hydralazine 37.5 mg & isosorbide dinitrate 20 mg q6hr) 
 - Hypotension (severe or w/ organ dysfunction) Norepinephrine (epinephrine is another option in HFrEF with hypoperfusion) 
Rx 3 — Optimize the volume 
 - Fluid challenge if: hypoperfusion, no pulmonary congestion (no B-lines on ultrasound), assessment suggests total body hypovolemia 
 - Diuresis if: significant systemic/pulmonary congestion, assessment suggests total body volume overload 
Rx 4 — Consider inotrope (usually dobutamine/milrinone) for HFrEF if: 
 - (a) Normotensive patient with organ hypoperfusion 
 - (b) Refractory cardiogenic pulmonary edema in hypotensive patient 
 - Note: Digoxin may be considered a weak inotropic agent in patients With chronic AF, HFrEF, and refractory heart failure. 
Rx 5 — Treat underlying etiology 
 - New-onset tachyarrhythmia causing heart failure: cardioversion, antiarrhythmics 
 - Ischemic cardiomyopathy: Revascularization, treatment for acute MI if present 
Rx 6 — Mechanical circulatory support 
 - Consider for persistent Organ failure — device Of choice is patient/institution specific. 
Rx 7 — Things to avoid 
 - Nephrotoxins (e.g. NSAlDs, ACE-inhibitors, angiotensin receptor blockers) 
 - Initiation of beta-blocker in decompensated heart failure 
 - Any beta-blocker or calcium channel blocker (eg diltiazem) in a patient with cardiogenic shock


#Checklist #CHF #Shock #Cardiogenic #HeartFailure #Cardiology #Management
Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
Medical jobs
view all

0 Comments

Related content