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Acute Heart Failure

Categories of Acute Heart Failure

  • Acute Decompensated HF
    • With signs and symptoms of AHF which are mild and do not complete criteria for cardiogenic shock, pulmonary edema, or hypertensive crisis
  • Hypertensive AHF
    • HF w/elevated BP and relatively preserved LV function with a CXR with acute pulmonary edema
  • AHF with Pulmonary Edema
    • Severe respiratory distress with crackles and orthopnea
  • High-Output Heart Failure
    • High CO, commonly with elevated HR 2/2 arrhythmia, thyrotoxicosis, anemia, Paget’s Disease, Iatrogenic
  • Right-Sided Heart Failure
    • Low CO with increased JVD, hepatomegaly, and hypotension
  • Cardiogenic Shock


  • Dry-Warm: Adjust oral therapy
  • Dry-Cold: Fluid Challenge/Inotropes
  • Wet-Warm:
    • Hypertension: Vasodilators/Diuretics
    • Congestion: Diuretics, Vasodilators, Ultrafiltration
  • Wet-Cold:
    • Systolic <90: Inotropes, Vasopressors, Diuretics, Circulatory support
    • Systolic >90: Vasodilators, Diuretics, Inotropes