Algorithm for the treatment of acute heart failure

  1. Hypotension is diagnosed if systolic blood pressure does not exceed 90 mm Hg. Art.
  2. Shock is a clinical syndrome characterized by, in addition to hypotension, signs of reduced perfusion of peripheral tissues (cold skin, oligoanuria, lethargy and lethargy).
  3. Breathing with 100% oxygen through a mask with a non-reversible valve and a bag-tank at an oxygen supply rate of 5–6 l / min).
  4. To correct the pumping function of the left ventricle, blood pressure should be initially normalized. In case of arterial hypotension / cardiogenic shock, it is initially necessary to make sure that the ventricles of the heart are sufficiently filled with pressure (no absolute or relative hypovolemia). In an emergency in the absence of pulmonary edema, it is advisable to quickly inject 250 to 500 ml of fluid intravenously, possibly repeatedly (by controlling the degree of stagnation in the lungs and, if possible, at least central venous pressure). If a sufficient increase in blood pressure is not achieved, infusion of a pressor agent should be initiated, the choice of which depends on the level of blood pressure. In the presence of hypovolemia, it is important to identify and, if possible, eliminate its cause. In cases where pulmonary edema is combined with increased blood pressure, it is necessary to reduce it by infusion of nitroglycerin or sodium nitroprusside.To correct myocardial contractility, other existing disorders should also be eliminated (hypoxia, hypoglycemia, drug overdose). In addition, rapid restoration of normal myocardial blood supply (thrombolytic therapy or invasive methods of myocardial revascularization during occlusion of a large epicardial coronary artery), as well as surgical correction of existing intracardiac hemodynamics, may be well as surgical correction of existing intracardiac hemodynamic well as surgical correction of existing intracardiac hemodynamic disorders.
  5. The norepinephrine infusion rate is 0.5–30 mcg / kg / min, the dopmin infusion rate is 2.5–20 mcg / kg / min.
  6. Simultaneous (but not isolated infusion of dobutamine) is possible. Dobutamine is the drug of choice for myocardial infarction of the right ventricle (it is also important to administer intravenous fluids, not using vasodilators and diuretics).
  7. Dobutamine infusion rate 2–20 mcg / kg / min.
  8. Perhaps the use of intra-aortic balloon contraception (considered as a temporary measure before conducting invasive interventions – myocardial revascularization using angioplasty procedure, coronary artery bypass surgery, surgical correction of intracardiac hemodynamics, heart transplantation).
  9. For the correction of high blood pressure in the acute phase of myocardial infarction, nitroglycerin is preferable, and in the absence of myocardial ischemia, sodium nitroprusside is preferable.
  10. First-line interventions, in addition to intravenous administration of morphine and a diuretic (furosemide), also include giving the patient a half-sitting position with his legs down and ensuring breathing with 100% oxygen. With systolic blood pressure above 100 mm Hg. Art. you should start taking nitroglycerin (1 tablet every 5 to 10 minutes) or isosorbiddinitrate as an aerosol until it is possible to administer intravenous infusion of nitroglycerin. If there is no response to the first dose of furosemide, a double dose should be administered within 20 minutes. A ventilator should be started when the arterial blood oxygen saturation drops to 90%, the oxygen tension in the arterial blood reaches 60 mm Hg. Art. when breathing 100% oxygen, as well as clinical manifestations of brain hypoxia (drowsiness, lethargy), a progressive increase in the voltage of carbon dioxide in the blood or an increase in acidosis.In milder cases, it is possible to evaluate the effectiveness of creating a positive pressure at the end of exhalation or breathing under constant positive pressure.
  11. Intravenous nitroglycerin is assigned to second-line drugs due to the time lag before the start of treatment. The administration of positive inotropic agents (dobutamine in the absence of arterial hypotension and dopmine in its presence) is assigned to the same group of interventions.
  12. Amrinone as a positive inotropic agent and a vasodilator is administered at a loading dose of 0.75 mg / kg for 2–3 minutes followed by an infusion of 5–15 µg / kg / min. Euphyllinum is administered with severe bronchospasm at a loading dose of 5 mg / kg in 20-30 minutes, followed by an infusion of 0.5-0.7 mg / kg / h. Its use should be avoided with supraventricular tachyarrhythmias. Intra-aortic balloon contraception is considered as a temporary measure before invasive interventions (myocardial revascularization using an angioplasty procedure, coronary artery bypass surgery, surgical correction of intracardiac hemodynamics, heart transplant).

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