Clinical Presentation
The most common initial symptom of acute decompensated heart failure is
Shortness of breath
This class of medications is commonly used to reduce fluid overload and improve symptoms of acute decompensated heart failure
Diuretics
These are the two key hemodynamic parameters used to categorize patients into the Forrester Classes of acute decompensated heart failure
CI and PCWP
True or False: SGLT2's are appropriate to use in type 1 diabetics.
FALSE
This is the fluid restriction for patients with ADHF.
2L
This sign/symptom is often associated with fluid retention in patients with acute decompensated heart failure (besides SOB)
Edema
Patients who fall under Forrester Classification 1 are recommended to be treated with these medications
Optimizing GDMT
This diagnostic lab test for ADHF takes a patient's age into consideration when interpreting the results
NT-proBNP
This drug class requires a washout period when switching to ARNI
ACE inhibitors
True or False: ADHF only occurs in patients with diagnosed congestive heart failure.
False
In the Forrester Classification, this class represents patients with high cardiac output and low pulmonary capillary wedge pressure
Class I – These patients are considered "warm and dry," indicating adequate cardiac output and no congestion.
This IV positive inotropic agent is commonly used in patients with severe hypotension and acute decompensated heart failure to improve cardiac output
Dobutamine
These are some hemodynamic findings you would see in a patient presenting with ADHF (List 3)
Hypotension, Tachycardia, decrease CO/CI, increased PCWP/SVR/CVP
These beta blockers are preferred in GDMT
Carvedilol, bisoprolol, metoprolol succinate
Name 3 drugs that may worsen heart failure.
NSAIDs, antiarrhythmics, pregabalin, stimulants, itraconazole, TZDs,
A patient with "cold and wet" symptoms would likely exhibit these signs related to poor perfusion and fluid overload
Cool extremities, hypotension, and pulmonary edema
These are the treatment recommendations for patients who present with adequate perfusion + fluid overload
IV diuretics +/- IV vasodilators
This ECHO finding would most likely be seen in a patient with acute decompensated heart failure
Reduced LVEF
One of the main side effects of spironolactone is this, which can be dangerous if not closely monitored, particularly in patients with renal impairment.
Hyperkalemia
The use of this vasodilator in ADHF can help reduce preload and afterload, improving symptoms, though it requires careful blood pressure monitoring due to the risk of hypotension
Nitroglycerin
A patient with "warm and dry" symptoms would likely present with these findings due to adequate cardiac output and no fluid congestion.
These are the treatment recommendations for patients who present with poor perfusion and fluid overload
IV diuretics
IV inotropes for SBP <90 +/- vasopressors
IV vasodilators for SBP >90
In ADHF, a PCWP of greater than 18mmHg indicates pulmonary congestion, and a CI of less than 2.2L/min/m indicates poor perfusion. These clinical findings might be seen in a patient with a PCWP of 22 and a CI 2.5.
Warm and Wet - adequate perfusion, shortness of breath, edema
This drug class has hard eGFR cutoffs for administration and a common side effect of these medications is UTI/yeast infection
SGLT2
If these weight gain parameters are met, it is recommended that patients contact their provider ASAP
Gain of 2 pounds in 1 day
Gain of 5 lbs in 1 week