Use vasopressor for hypotension before vasodilators
Identify and treat precipitants
ACS
Arrhythmia
Infection
PE
Harm avoidance
Routine opioids associated with worse outcomes
Excess IV fluids worsen pulmonary edema
Inotropes increase arrhythmia risk and should be reserved for hypoperfusion
Patient Discharge Instructions
Copy discharge instructions
Home plan
Daily weights
Same time each morning
Same clothing
Fluid plan
Follow clinician target for daily intake
Avoid excess alcohol
Salt plan
Avoid high salt foods
Avoid added salt
Medication plan
Take diuretic exactly as prescribed
Do not stop HF meds without clinician advice
Follow up
Primary care or HF clinic within 72 hours to 7 days
Lab check for potassium and creatinine as directed
Return now or call emergency services
Trouble breathing at rest
Chest pain
Fainting or near fainting
Blue lips or severe sweating with breathlessness
Confusion or severe drowsiness
SpO2 below personal target if home oximeter
Weight gain
>= 2 kg in 2 days
>= 2.5 kg in 1 week
Swelling rapidly worsening
Not peeing much for 12 hours with swelling or breathlessness
References
Clinical guidelines and consensus
Heart failure guidelines
ACC AHA HFSA guideline for management of heart failure
Class I recommendations for IV loop diuretics in congestion
Disease modifying therapy framework for chronic HF
ESC guideline for acute and chronic heart failure
NIV support for cardiogenic pulmonary edema
Vasodilator use in hypertensive pulmonary edema with adequate BP
Cardiogenic shock guidance
Society consensus statements on vasopressor choice
Norepinephrine preferred first line in hypotensive shock
Evidence based sources
Diuretic strategy trials
DOSE trial
Bolus versus infusion comparisons
High dose versus low dose comparisons
Adjunct decongestion trials
ADVOR trial
Acetazolamide plus loop diuretic improved decongestion
NIV evidence
Meta analyses in acute cardiogenic pulmonary edema
Reduced intubation rates with CPAP or BiPAP
Risk prediction tools
ADHERE registry derivations
EHMRG derivations and validations
GWTG-HF risk score derivations
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.