EC Microbiology

Introduction: An increased rate of mortality and morbidity is seen in patients with acute heart failure. Doctors working in the emergency department (ED) very frequently deal with patients with acute heart failure, and the number goes up to 6 lacs in the emergency departments in the United States. The sedentary lifestyle and increased intake of high-calorie food in the form of junk food predispose many people to a risk of heart failure. Acute heart failure has many causative factors, with the end result being reduced perfusion and increased cardiac pressure. The most important aim of treatment is the correction of hemodynamics and treatment of the underlying disease leading to the failure.

Aim of Study: This review aims at overviewing the emergent management of Heart Failure.

Methodology: This review is a comprehensive research of PUBMED and Google Scholar from the year 2004 to 2018.

Conclusion: A huge number of emergency department admissions account for acute heart failure patients. Emergent management of patients in the ED helps to decrease the overall mortality rate associated with heart failure. Once the patient is admitted to the ED with heart failure, it’s better to categorize it according to the present blood pressure and systemic overload. Nitroglycerin is the preferred choice for hypertensive patients, and cases with increased systemic overload require diuretics. Mechanical circulatory devices can be used for better circulation in patients with Cardiogenic shock. Underlying etiology should be kept in mind, and all efforts should be put to elite the underlying etiology. Once the emergent treatment is done, patients should be divided into high-risk, and low-risk factors category and disposition should be done accordingly. Keywords: Acute Heart Failure; Mechanical Circulating Devices; Atrial Fibrillation; Systemic Overload; Diuretics; Vasoconstrictors

1. Cowie MR. “The heart failure epidemic: a UK perspective”. Echo Research and Practice1 (2017): R15-R20.
2. Bleumink GS., et al. “Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure: the Rotterdam Study”. European Heart Journal18 (2004): 1614-1619.
3. Emdin CA., et al. “Variation in hospital performance for heart failure management in the National Heart Failure Audit for England and Wales”. Heart 1 (2017): 55-62.
4. Maisel AS., et al. “Timing of immunoreactive B-type natriuretic peptide levels and treatment delay in acute decompensated heart failure: an ADHERE (Acute Decompensated Heart Failure National Registry) analysis”. Journal of the American College of Cardiology7 (2008): 534-540.
5. Long B., et al. “Management of heart failure in the emergency department setting: an evidence-based review of the literature”. The Journal of Emergency Medicine5 (2018): 635-646.
6. Ural D., et al. “Diagnosis and management of acute heart failure”. Anatolian Journal of Cardiology11 (2016): 860.
7. Felker GM., et al. “Diuretic strategies in patients with acute decompensated heart failure”. New England Journal of Medicine9 (2011): 797-805.
8. Salvador DRK., et al. “Continuous infusion versus bolus injection of loop diuretics in congestive heart failure”. Cochrane Database of Systematic Reviews 1 (2004): CD003178.
9. Kuo DC and Peacok WF. “Diagnosing and managing acute heart failure in the emergency department”. Clinical and Experimental Emergency Medicine3 (2015): 141.
10. Gray A., et al. “Noninvasive ventilation in acute cardiogenic pulmonary edema”. New England Journal of Medicine2 (2008): 142- 151.
11. Minuto A., et al. “Non-invasive mechanical ventilation in patients with acute cardiogenic pulmonary edema”. Minerva Anestesiologica11 (2003): 835-838.
12. Mattu A., et al. “Modern management of cardiogenic pulmonary edema”. Emergency Medicine Clinics4 (2005): 1105-1125.
13. Levy P., et al. “Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis”. Annals of Emergency Medicine2 (2007): 144-152.
14. Sackner-Bernstein JD., et al. “Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure”. Circulation12 (2005): 1487-1491.
15. Hashim T., et al. “Clinical characteristics and outcomes of intravenous inotropic therapy in advanced heart failure”. Circulation: Heart Failure5 (2015): 880-886.
16. Reynolds HR and Hochman JS. “Cardiogenic shock: current concepts and improving outcomes”. Circulation5 (2008): 686-697.
17. Mebazaa A., et al. “Short-term survival by treatment among patients hospitalized with acute heart failure: the global ALARM-HF registry using propensity scoring methods”. Intensive Care Medicine2 (2011): 290-301.
18. De Backer D., et al. “Comparison of dopamine and norepinephrine in the treatment of shock”. New England Journal of Medicine9 (2010): 779-789.
19. Mandawat A and Rao SV. “Percutaneous mechanical circulatory support devices in cardiogenic shock”. Circulation: Cardiovascular Interventions5 (2017): e004337.
20. Reddy YN., et al. “High-output heart failure: a 15-year experience”. Journal of the American College of Cardiology5 (2016): 473-482.
21. Mehta PA and Dubrey SW. “High output heart failure”. QJM: An International Journal of Medicine4 (2009): 235-241.
22. Long B., et al. “Emergency medicine considerations in atrial fibrillation”. The American Journal of Emergency Medicine6 (2018): 1070-1078.
23. Authors/Task Force Members, Camm A J., et al. “2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation Developed with the special contribution of the European Heart Rhythm Association”. European Heart Journal21 (2012): 2719-2747.