HEART FAILURE-ACUTE MANAGEMENT

SUMMARY

1. May require short-time treatment with inotropes (dopamine, dobutamine, milrinone). 2. Dobutamine: does not have the vasoconstrictor activity of dopamine and actually has some vasodilatory effects.
- At < 2 mcg/kg/min: mesenteric dilation
- At 2-5 mcg/kg/min: positive inotrope, increases renal perfusion
- At > 10 mcg/kg/min: vasoconstriction

3. Mechanical circulatory support (MCS) is beneficial in selected patients with Stage D HF in whom cardiac transplantation or cardiac recovery is anticipated.

4. Revascularization (CABG or PCI) is indicated for patients on optimal medical therapy with angina and suitable anatomy (left main stenosis > 50%).

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].