How is acute left heart failure treated?
Aug 11, 2021
Source: Cainiu Health
Dr. Zhang Min
Introduction
How to treat acute left heart failure: When acute left heart failure occurs, the patient should first be placed in a semi-Fowler’s or upright sitting position with legs dangling. High-flow oxygen therapy with ethanol humidification should be administered, along with continuous electrocardiographic (ECG) monitoring and indwelling urinary catheterization to facilitate accurate monitoring of intake and output. Pharmacologic management begins with sedation—morphine is the preferred agent. For diuresis, a rapid-acting loop diuretic should be selected.
During an acute left heart failure episode, the patient should first be placed in a semi-Fowler’s or upright sitting position with legs dangling. High-flow oxygen therapy humidified with ethanol should be administered, along with continuous electrocardiographic (ECG) monitoring and indwelling urinary catheterization to facilitate accurate assessment of fluid intake and output.
Pharmacologic management begins with sedation—morphine may be administered intravenously or subcutaneously. Diuretics should be rapid-acting loop diuretics (e.g., furosemide) to promptly alleviate pulmonary congestion and reduce both preload and afterload on the myocardium. Vasodilators—particularly intravenous sodium nitroprusside—are preferred to relieve heart failure by reducing systemic vascular resistance. Cardiotonic agents such as digoxin may be used, while positive inotropic agents like milrinone are also options. In cases of bronchospasm, bronchodilators (e.g., aminophylline) should be administered. Additionally, for patients with refractory heart failure unresponsive to conventional therapies, newer agents—including recombinant human brain natriuretic peptide (nesiritide) and levosimendan—may be considered.
