A 72-year-old man with a history of ischemic cardiomyopathy and a left ventricular ejection fraction of 30% presents to the emergency department with severe, worsening shortness of breath over the past 3 days. He reports orthopnea and paroxysmal nocturnal dyspnea. His blood pressure is 165/95 mm Hg, heart rate is 110/min, and respiratory rate is 28/min. Oxygen saturation is 89% on room air. Physical examination reveals jugular venous distention, bibasilar crackles extending halfway up the lung fields, and 3+ bilateral pitting pedal edema. Which of the following pharmacologic interventions are appropriate for the initial management of this patient's acute presentation? (Select all that apply)
- Intravenous loop diuretics (e.g., furosemide)Cevap
- Intravenous vasodilators (e.g., nitroglycerin)Cevap
- CIntravenous non-dihydropyridine calcium channel blockers (e.g., verapamil)
- DIntravenous beta-blockers (e.g., metoprolol)
- EIntravenous fluid resuscitation with 0.9% normal saline
Cevap
The appropriate interventions are intravenous loop diuretics and intravenous vasodilators.
The correct interventions focus on reducing cardiac preload and managing fluid overload. Intravenous loop diuretics, such as furosemide, are the first-line therapy to promote diuresis and rapidly relieve pulmonary congestion. Additionally, in patients with acute decompensated heart failure who are hypertensive or normotensive, intravenous vasodilators like nitroglycerin are indicated to rapidly decrease preload and alleviate dyspnea.
Adım Adım Çözüm
Anahtar Kavram
Initial pharmacologic management of acute decompensated heart failure prioritizes preload and afterload reduction while strictly avoiding negative inotropes and additional volume.