Pharmacologic management of acute heart failure
Heart failure is perhaps the most important health problem in cardiovascular medicine. Acute heart failure, especially acute exacerbation of chronic heart failure, is an increasingly common clinical scenario. The goals of pharmacologic management are hemodynamic stabilization, relief of symptoms of congestion and volume overload, and finally titration of standard oral therapy to improve long-term outcome. Standard therapy includes morphine, nitrates, loop diuretics, and angiotensin-converting enzyme inhibitors with early titration toward doses with proven mortality benefit. A treatment strategy of early short-term use of inotropic support has become more common, though randomized evidence for improved long-term clinical outcomes with this strategy are not yet available. This review focuses on the standard pharmacologic and therapeutic approaches to acute heart failure and comments on areas in which development continues.
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