Acute Decomp Heart Failure.pdf


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Acute Decompensated
Heart Failure:
New Strategies for
Improving Outcomes

May 2017

Authors

Volume 19, Number 5

Emily Singer Fisher, MD

Assistant Professor, Department of Emergency Medicine, University of
Oklahoma School of Community Medicine, Tulsa, OK

Boyd Burns, DO, FACEP, FAAEM

George Kaiser Foundation Chair in Emergency Medicine, Associate
Professor & Program Director, Department of Emergency Medicine,
University of Oklahoma School of Community Medicine, Tulsa, OK
Peer Reviewers

Abstract

Sinem Sherifali, MD

Acute decompensated heart failure is a common emergency
department presentation with significant associated morbidity
and mortality. Heart failure accounts for more than 1 million
hospitalizations annually, with a steadily increasing incidence
as our population ages. This issue reviews recent literature
regarding appropriate management of emergency department
presentations of acute decompensated heart failure, with special
attention to newer medication options. Emergency department
management and appropriate interventions are discussed, along
with critical decision-making points in resuscitation for both
hypertensive and hypotensive patients.

Assistant Professor of Emergency Medicine, University of Florida
Jacksonville, Jacksonville, FL

Scott M. Silvers, MD

Associate Professor and Chair, Department of Emergency Medicine, Mayo
Clinic, Jacksonville, FL
CME Objectives
Upon completion of this article, you should be able to:
1.
2.
3.

Diagnose acute exacerbations of heart failure using a focused
physical examination and appropriate adjunct testing.

Identify alternative causes of dyspnea and discuss how to distinguish
them from heart failure.

Determine the appropriate ED management of acute decompensated
heart failure and manage those at risk for rapid deterioration.
Prior to beginning this activity, see “Physician CME Information”
on the back page.

Editor-In-Chief
Andy Jagoda, MD, FACEP
Professor and Chair, Department of
Emergency Medicine, Icahn School
of Medicine at Mount Sinai, Medical
Director, Mount Sinai Hospital, New
York, NY

Associate Editor-In-Chief
Kaushal Shah, MD, FACEP
Associate Professor, Department of
Emergency Medicine, Icahn School
of Medicine at Mount Sinai, New
York, NY

Editorial Board

Daniel J. Egan, MD
Associate Professor, Department
of Emergency Medicine, Program
Director, Emergency Medicine
Residency, Mount Sinai St. Luke's
Roosevelt, New York, NY
Nicholas Genes, MD, PhD
Associate Professor, Department of
Emergency Medicine, Icahn School
of Medicine at Mount Sinai, New
York, NY
Michael A. Gibbs, MD, FACEP
Professor and Chair, Department
of Emergency Medicine, Carolinas
Medical Center, University of North
Carolina School of Medicine, Chapel
Hill, NC

Saadia Akhtar, MD
Associate Professor, Department of
Emergency Medicine, Associate Dean Steven A. Godwin, MD, FACEP
for Graduate Medical Education,
Professor and Chair, Department
Program Director, Emergency
of Emergency Medicine, Assistant
Medicine Residency, Mount Sinai
Dean, Simulation Education,
Beth Israel, New York, NY
University of Florida COMJacksonville, Jacksonville, FL
William J. Brady, MD
Gregory L. Henry, MD, FACEP
Professor of Emergency Medicine
Clinical Professor, Department of
and Medicine; Chair, Medical
Emergency Medicine, University
Emergency Response Committee;
of Michigan Medical School; CEO,
Medical Director, Emergency
Medical Practice Risk Assessment,
Management, University of Virginia
Inc., Ann Arbor, MI
Medical Center, Charlottesville, VA
Calvin A. Brown III, MD
Director of Physician Compliance,
Credentialing and Urgent Care
Services, Department of Emergency
Medicine, Brigham and Women's
Hospital, Boston, MA
Peter DeBlieux, MD
Professor of Clinical Medicine,
Interim Public Hospital Director
of Emergency Medicine Services,
Louisiana State University Health
Science Center, New Orleans, LA

John M. Howell, MD, FACEP
Clinical Professor of Emergency
Medicine, George Washington
University, Washington, DC; Director
of Academic Affairs, Best Practices,
Inc, Inova Fairfax Hospital, Falls
Church, VA
Shkelzen Hoxhaj, MD, MPH, MBA
Chief Medical Officer, Jackson
Memorial Hospital, Miami, FL

Robert Schiller, MD
Eric Legome, MD
Chair, Department of Family Medicine,
Chair, Emergency Medicine, Mount
Beth Israel Medical Center; Senior
Sinai West & Mount Sinai St. Luke's;
Faculty, Family Medicine and
Vice Chair, Academic Affairs for
Community Health, Icahn School of
Emergency Medicine, Mount Sinai
Medicine at Mount Sinai, New York, NY
Health System, Icahn School of
Medicine at Mount Sinai, New York, NY Scott Silvers, MD, FACEP
Associate Professor and Chair,
Keith A. Marill, MD
Department of Emergency Medicine,
Research Faculty, Department of
Mayo Clinic, Jacksonville, FL
Emergency Medicine, University
of Pittsburgh Medical Center,
Corey
M. Slovis, MD, FACP, FACEP
Pittsburgh, PA
Professor and Chair, Department
Charles V. Pollack Jr., MA, MD,
of Emergency Medicine, Vanderbilt
FACEP
University Medical Center, Nashville, TN
Professor and Senior Advisor for
Ron M. Walls, MD
Interdisciplinary Research and
Professor and Chair, Department of
Clinical Trials, Department of
Emergency Medicine, Brigham and
Emergency Medicine, Sidney Kimmel
Women's Hospital, Harvard Medical
Medical College of Thomas Jefferson
School, Boston, MA
University, Philadelphia, PA
Michael S. Radeos, MD, MPH
Associate Professor of Emergency
Medicine, Weill Medical College
of Cornell University, New York;
Research Director, Department of
Emergency Medicine, New York
Hospital Queens, Flushing, NY
Ali S. Raja, MD, MBA, MPH
Vice-Chair, Emergency Medicine,
Massachusetts General Hospital,
Boston, MA
Robert L. Rogers, MD, FACEP,
FAAEM, FACP
Assistant Professor of Emergency
Medicine, The University of
Maryland School of Medicine,
Baltimore, MD
Alfred Sacchetti, MD, FACEP
Assistant Clinical Professor,
Department of Emergency Medicine,
Thomas Jefferson University,
Philadelphia, PA

Critical Care Editors

International Editors
Peter Cameron, MD
Academic Director, The Alfred
Emergency and Trauma Centre,
Monash University, Melbourne,
Australia
Giorgio Carbone, MD
Chief, Department of Emergency
Medicine Ospedale Gradenigo,
Torino, Italy
Suzanne Y.G. Peeters, MD
Attending Emergency Physician,
Flevo Teaching Hospital, Almere,
The Netherlands
Hugo Peralta, MD
Chair of Emergency Services,
Hospital Italiano, Buenos Aires,
Argentina
Dhanadol Rojanasarntikul, MD
Attending Physician, Emergency
Medicine, King Chulalongkorn
Memorial Hospital, Thai Red Cross,
Thailand; Faculty of Medicine,
Chulalongkorn University, Thailand

William A. Knight IV, MD, FACEP
Associate Professor of Emergency
Medicine and Neurosurgery, Medical
Director, EM Advanced Practice
Provider Program; Associate Medical Stephen H. Thomas, MD, MPH
Director, Neuroscience ICU, University Professor & Chair, Emergency
of Cincinnati, Cincinnati, OH
Medicine, Hamad Medical Corp.,
Weill Cornell Medical College, Qatar;
Scott D. Weingart, MD, FCCM
Emergency Physician-in-Chief,
Associate Professor of Emergency
Hamad General Hospital,
Medicine; Director, Division of ED
Doha, Qatar
Critical Care, Icahn School of Medicine
at Mount Sinai, New York, NY

Senior Research Editors
Aimee Mishler, PharmD, BCPS
Emergency Medicine Pharmacist,
Maricopa Medical Center, Phoenix, AZ

Edin Zelihic, MD
Head, Department of Emergency
Medicine, Leopoldina Hospital,
Schweinfurt, Germany

Joseph D. Toscano, MD
Chairman, Department of Emergency
Medicine, San Ramon Regional
Medical Center, San Ramon, CA

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