Today in Morning Report, we walked through a case of decompensated heart failure.
We learned that it is not only important to treat decompensated heart failure by decreasing preload and afterload, but it is equally important to look for the precipitant of decompensation.
Medications (either changes in doses, additions, or discontinuations, top culprits include NSAIDS, ACE inhibitors/ARBs, beta-blockers, CCBs)
Dietary indiscretion
Iatrogenic volume overload (read: the "unnecessary" continuous intravenous fluid infusion)
Cardiac
- Valvular disease (e.g. aortic stenosis or acute or progressive mitral regurgitation)
- Myocardial infarction and myocardial ischemia
- Progression of underlying cardiac dysfunction
- Cardiomyopathy (inherited, such as HOCM, vs acquired, such as Takotsubo cardiomyopathy and cardiotoxic agents such as alcohol, cocaine, and some chemotherapeutic agents, like anthracyclines)
- Arrythmias (e.g. atrial fibrillation, and less commonly, atrial flutter, sinus tachycardia, other supraventricular tachycardias, and ventricular tachycardia)
Severe hypertension (increasing afterload)
Renal failure
Infections (e.g. UTIs, pneumonia)
Anemia
Metabolic (e.g. hypo- or hyperthyroidism)
Pulmonary embolism
Click here for a link to the 2009 Canadian Cardiovascular Society consensus guidelines on the diagnosis and management of right-sided heart failure.
