title: Congestive Heart Failure.
abstract: Patients with acute decompensated heart failure are usually critically ill and require immediate treatment. However, most are not volume overloaded. Emergency department (ED) management is based on rapid initiation of noninvasive positive-pressure ventilation and aggressive titration of nitrates. Afterload reduction with an angiotensin-converting enzyme inhibitor can be considered. A diuretic should not be administered before optimal preload and afterload reduction has been achieved. Short-term inotropic therapy can be considered in select patients with cardiogenic shock and acute decompensated heart failure (ADHF) who fail to respond to standard therapy.
authors.affiliation: Emergency Medicine/Internal Medicine/Critical Care Program, Department of Emergency Medicine, University of Maryland Medical Center, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Department of Medicine, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Scott
authors.affiliation: Emergency Medicine/Internal Medicine/Critical Care Program, Department of Emergency Medicine, University of Maryland Medical Center, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. Electronic address: mwinters@umem.org.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Winters
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D011175:Positive-Pressure Respiration; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D004232:Diuretics; D014665:Vasodilator Agents
keywords: Acute decompensated heart failure; Angiotensin converting enzyme inhibitors; Congestive heart failure; Diuretics; Inotropes; Nitrates; Noninvasive positive pressure ventilation