Management of acute heart failure and acute pulmonary edema: What you need to know

The article is professionally consulted by Master, Doctor Huynh Khiem Huy - Cardiac Resuscitation Doctor - Cardiovascular Center - Vinmec Central Park International General Hospital

Acute heart failure is a complex clinical syndrome. Most patients with acute heart failure admitted to the hospital have fluid overload, signs of blood stasis, or may experience hypotension and organ hypoperfusion.

Acute heart failure due to hypertensive crisis Acute coronary syndrome with heart failure Acute pulmonary edema Cardiogenic shock Acute decompensated heart failure Right heart failure

2.1. Symptoms The patient suddenly feels short of breath, hungry for air, coughs, spits up pink foam, drowns. Patients often have to sit up and do not speak enough sentences Breathing rate increases, respiratory muscle contractions Sweating, cyanosis

2.2. Physical symptoms Heart rate, blood pressure increase : Due to increased sympathetic activity SpO2 usually < 90% Lungs: Snoring rales, basal moist rales Heart: T3, T4 sounds

3.1. At the primary level Symptomatic treatment Provide oxygen Improve organ perfusion and hemodynamics Avoid heart and kidney damage Prevent venous thrombosis Reduce ICU stay 3.2. In cardiology Have a reasonable treatment strategy Provide initial therapy Find causes and predisposing factors

3.3. Before hospital discharge and long-term maintenance treatment Have a long-term follow-up strategy Diet and lifestyle guidelines Have an optimal heart failure medication plan Improve symptoms, quality of life

4.1. Use of diuretics Depends on the patient's fluid retention
Moderate: 20-40mg furosemide orally or intravenously Severe: 40-100mg furosemide intravenously, may increase dose or 5-40mg/h furosemide IV In case of poor response to furosemide: Add 50-100mg of thiazides in combination with furosemide, the effect is better than increasing the high dose of furosemide or 25-50mg of spironolactone in combination with furosemide if there is no renal failure In case of poor response to furosemide and thiazides: Add dopamine or dobutamine. Consider dialysis or ultrafiltration in patients with renal failure. 4.2. Give oxygen as soon as possible Goal: raise SpO2 >= 95% (>90% in COPD patients)

4.3. Morphine Early morphine should be used in patients with acute heart failure with symptoms of restlessness, dyspnea, anxiety, and chest pain. Morphine relieves dyspnea and other symptoms Improves cooperation when NIV Bolus 2.5-5mg can be repeated as needed Respiratory monitoring Common side effects: vomiting Caution in patients with hypotension, bradycardia, high BAV or hypercapnia.

4.4 Vasodilators Including nitroglycerin and nitroprusside Recommended for use in patients with early acute heart failure in the absence of symptoms of hypotension (systolic blood pressure < 90 mmHg) or severe obstructive disease. 4.5. Indications for vasopressors: Left ventricular dilatation, decreased EF accompanied by: Low blood pressure (systolic blood pressure < 90 mmHg) Or low cardiac output

4.6. Non-invasive ventilation Non-invasive mechanical ventilation with positive end-expiratory pressure should be indicated as soon as possible in patients with acute pulmonary edema and hypertensive acute heart failure. Clinical improvement Improves left ventricular systolic function by reducing left ventricular afterload Caution in patients with cardiogenic shock and right heart failure 4.7. Other treatments Hemodialysis ECMO Arterial balloon pump Surgery if indicated: CABG, acute mitral valve repair/replacement, acute aortic valve replacement. Acute heart failure and acute pulmonary edema are cardiovascular emergencies. In order to have an effective and appropriate management strategy, it is necessary to find out the cause and accurately assess the disease situation in each patient. Currently, mechanical assist devices play an increasingly important role in the treatment and management of acute heart failure.
Master. Dr. Huynh Khiem Huy has more than 11 years of experience working in the field of cardiovascular resuscitation anesthesia; examination and resuscitation treatment after surgery for cardiovascular diseases in adults and children. Dr. Huy was former deputy head of the Department of Surgical Resuscitation at Tam Duc Heart Hospital before being a cardiothoracic surgeon in Cardiovascular Surgery, Cardiovascular Center - Vinmec Central Park International General Hospital

The article references the source: Vietnam Association of Vietnamese Studies