Heart Failure Acute Decompensation Algorithm
Note: This document provides a structured summary of the Heart Failure Acute Decompensation Algorithm for educational and reference purposes. It is not a substitute for certified ACLS training and adherence to the latest guidelines published by the American Heart Association (AHA) or other relevant governing bodies. Always consult the most current official guidelines.
Patient presents with new or worsening symptoms of heart failure (dyspnea, fatigue, edema).
ABCs, vital signs, physical exam (rales, edema, JVD), ECG, chest X-ray, labs (BNP/NT-proBNP, troponin, electrolytes, renal function).
Assess for congestion (“wet” vs “dry”) and perfusion (“warm” vs “cold”).
Most common profile. Focus on reducing congestion.
Requires treatment for both congestion and hypoperfusion.
Focus on improving perfusion, often with fluids or inotropes.
Patient is compensated. Optimize oral medications.
Diuretics (IV for wet), Vasodilators (NTG, Nesiritide), Inotropes (Dobutamine, Milrinone for cold), manage BP.
Assess symptoms, vital signs, urine output, weight, labs. Titrate medications as needed.
Ischemia, uncontrolled hypertension, arrhythmias, infection, non-adherence, renal dysfunction, PE.
Optimize oral medications, patient education, follow-up appointments, rehabilitation referral.
