ICU Vivas · Acute heart failure
Clinical viva — your approach to acute heart failure
A clinical viva on the approach to acute heart failure — the Nohria/Stevenson profiles, oxygen and NIV, the IV loop diuretic and its response check, vasodilators by blood pressure, cardiogenic shock, precipitants and GDMT.
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Prompt
A clinical viva on the approach to acute heart failure — the Nohria/Stevenson profiles, oxygen and NIV, the IV loop diuretic and its response check, vasodilators by blood pressure, cardiogenic shock, precipitants and GDMT.
The question
"Take me through your approach to a patient who presents with acute heart failure."[1]
References9ShowHide
- [1]Nohria A, Tsang SW, Fang JC, et al. Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure J Am Coll Cardiol, 2003.PMID 12767667
- [2]McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European heart journal, 2021.PMID 34447992
- [3]Gray A, Goodacre S, Newby DE, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema N Engl J Med, 2008.PMID 18614781
- [4]Mullens W, Damman K, Harjola VP, 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.PMID 30600580
- [5]Fonarow GC, Abraham WT, Albert NM, et al. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Archives of internal medicine, 2008.PMID 18443260
- [6]De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock N Engl J Med, 2010.PMID 20200382
- [7]Prins KW, Neill JM, Tyler JO, et al. Effects of Beta-Blocker Withdrawal in Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis. JACC. Heart failure, 2015.PMID 26251094
- [8]Mebazaa A, Davison B, Chioncel O, et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet (London, England), 2022.PMID 36356631
- [9]Felker GM, Lee KL, Bull DA, et al. Diuretic strategies in patients with acute decompensated heart failure N Engl J Med, 2011.PMID 21366472