Page 61 - Critical Care Notes

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■ In patients not responsive to loop diuretics, administer hydrochlorothiazide
(Microzide) indapamide, chlorthalidone (Thalitone), chlorothiazide (Diuril),
metolazone (Zaroxolyn), spironolactone (Aldactone), amiloride (Midamor),
or triamterene (Dyrenium).
■ Consider low-dose dopamine to support renal function.
■ Administer beta blockers to reduce cardiac workload, improve LV ejection
fraction, and prevent arrhythmias: metoprolol (Lopressor, Toprol XL),
carvedilol (Coreg), or bisoprolol (Zebeta).
■ Administer nitrates to enhance myocardial contractility and decrease LV
filling pressure and SVR: NTG, isosorbide, nitroprusside.
■ Administer inotropes to enhance myocardial contractility and increase
organ perfusion: dopamine, dobutamine, milrinone, and digoxin
(Lanoxin).
■ Administer ACE-IS to reduce peripheral resistance, afterload, preload, and
heart size: captopril enalapril (Vasotec), lisinopril (Prinivil), ramipril (Altace)
or quinapril (Accupril).
■ Administer angiotensin II receptor blockers to reduce afterload: losartan
(Cozaar), valsartan (Diovan), candesartan (Atacand), irbesartan (Avapro),
azilsartan (Edarbi).
■ Administer vasodilators if adequate BP to decrease preload and/or afterload
and SVR: nitroprusside (Nitropress) or hydralazine.
■ Administer nesiritide (Natrecor) to reduce PCWP and improve dyspnea.
■ Administer alpha-beta-adrenergic agonists to improve cardiac output and
organ perfusion: epinephrine or norepinephrine (Levophed).
■ Consider aldosterone antagonists in select cases: eplerenone (Inspra).
■ Administer anticoagulants to prevent thromboembolism: warfarin
(Coumadin), dabigatran (Pradaxa).
■ Consider sildenafil (Viagra) in select instances.
■ Administer morphine for pain.
■ Avoid NSAIDs and calcium channel blockers as they can exacerbate HF.
Many antiarrhythmics are also contraindicated in HF.
■ Prepare patient for biventricular pacemaker or AICD.
■ Other procedures that may be necessary include:
■ Ultrafiltration for patients who have significant volume overload
unresponsive to diuretics
■ Coronary artery bypass graft (CABG) or percutaneous coronary
intervention (PCI)
■ Valvular surgery on the aortic or mitral valve
■ Cardiac resynchronization therapy (CRT)
■ Ventricular restoration procedures
■ Extracorporeal membrane oxygenator (ECMO)
■ Ventricular assist device (VAD)
■ Heart transplant
CV