Suspected Acute Heart Failure — Escalation of Care — Clinical Pathway: Emergency, ICU and Inpatient

Suspected Acute Heart Failure Clinical Pathway — Emergency Department, ICU and Inpatient

Escalation of Care

If improvement is not achieved with initial management, consider the following:

  • Diastolic dysfunction
    • Intotropic and afterload reducing agents should be used with caution
  • Anticoagulation if severely depressed ventricular function
  • Escalating inotropes
  • Escalating respiratory support
    • Consider Cardiac Anesthesia for intubation
    • Consider ECMO stand by for intubation
  • Consider mechanical support
    • ECMO, other mechanical device
  • Continue diuretics
  • Vasodilators/milrinone if normotensive
  • Continue chronic HF medications
  • If hypotensive, add low-dose dopamine
    or epinephrine
  • Re-evaluate milrinone dosing if already in use
Symptom Relief
  • Transition from IV to PO Medication
  • Evaluate for transfer/discharge
  • Consider
  • Enhancing diuretic treatment
  • Escalating ionotropes
  • Escalating respiratory support
Consider
Mechanical Support