In<unk> , the immediate goal is to re-establish adequate perfusion and oxygen delivery to end organs. This entails ensuring that airway, breathing, and circulation are adequate. Management consists of propping up the head of the patient, giving oxygen to correct hypoxemia, administering morphine, diuretics like furosemide, addition of an ACE inhibitor, use of nitrates and use of digoxin if indicated for the<unk>  failure and if arrhythmic. Oxygen Supplemental oxygen may be administered if blood levels of oxygen are low; the<unk>  Failure Society of America, however, has recommended that it not be used routinely. Medication Initial therapy of<unk>  usually includes some combination of a vasodilator such as nitroglycerin, a loop diuretic such as furosemide, and non-invasive positive pressure ventilation (NIPPV). Even if symptoms of<unk>  failure are not present, medications can be used to treat the symptoms that are being experienced. These medicines work to control these symptoms as well as treat other<unk> h problems that might be present. They can work to improve the quality of life, slow down the progression of<unk>  failure and reduce the risk for other complications that can occur due to<unk>  failure. It is very important to take proper medicines exactly as prescribed by the physician. A number of different medications are required for people who are experiencing<unk>  failure. Common types of medications that are prescribed for<unk>  failure patients include ACE inhibitors, vasodilators, beta blockers, aspirin, calcium channel blockers, and cholesterol lowering medications such as statins. Depending on the type of damage a patient has suffered and the underlying cause of the<unk>  failure, any of these drug classes or a combination of them can be prescribed. Patients with<unk>  pumping problems will use a different medication combination than those who are experiencing problems with the<unk> 's ability to fill properly during diastole. Potentially dangerous drug interactions can occur when different drugs mix together and work against each other. Vasodilators Nitrates such as nitroglycerin are often used as part of the initial therapy for<unk> . Another option is nesiritide, although it should only be considered if conventional therapy has been ineffective or contraindicated as it is much more expensive than nitroglycerine and has not been shown to be of any greater benefit. Diuretics<unk>  failure is usually associated with a volume overloaded state. Therefore, those with evidence of fluid overload should be treated initially with intravenous loop diuretics. In the absence of symptomatic low blood pressure intravenous nitroglycerin is often used in addition to diuretic therapy to improve congestive symptoms. Volume status should still be adequately evaluated. Some<unk>  failure patients on chronic diuretics can undergo excessive diuresis. In the case of diastolic dysfunction without systolic dysfunction, fluid resuscitation may, in fact, improve circulation by decreasing<unk>  rate, which will allow the ventricles more time to fill. Even if the patient is edematous, fluid resuscitation may be the first line of treatment if the person's blood pressure is low. The person may, in fact, have too little fluid in their blood vessels, but if the low blood pressure is due to cardiogenic shock, the administration of additional fluid may worsen the<unk>  failure and associated low blood pressure. If the person's circulatory volume is adequate but there is persistent evidence of inadequate end-organ perfusion, inotropes may be administered. In certain circumstances, a left ventricular assist device (LVAD) may be necessary. Once the person is stabilized, attention can be turned to treating pulmonary edema to improve oxygenation. Intravenous furosemide is generally the first line. However, people on long-standing diuretic regimens can become tolerant, and dosages must be progressively increased. If high doses of furosemide are inadequate, boluses or continuous infusions of bumetanide may be preferred. These loop diuretics may be combined with thiazide diuretics such as oral metolazone or intravenous chlorothiazide for a synergistic effect. Intravenous preparations are physiologically preferred because of more predictable absorption due to intestinal edema, however, oral preparations can be significantly more cost effective. Others ;ACE inhibitors and ARBs The effectiveness and safety of ACE inhibitors and angiotensin receptor blockers acutely in<unk>  have not been well studied, but are potentially harmful. A person should be stabilized before therapy with either of these medication classes is initiated. Individuals with poor kidney perfusion are especially at risk for kidney impairment inherent with these medications. ;Beta-blockers Beta-blockers are stopped or decreased in people with acutely<unk><unk>  failure and a low blood pressure. However, continuation of beta-blockers may be appropriate if the blood pressure is adequate. ;Inotropic agents Inotropes are indicated if low blood pressure ( SBP < 90 mmHg ) is present. ;Opioids Opioids have traditionally been used in the treatment of the acute pulmonary edema that results from<unk> . A 2006 review, however, found little evidence to support this practice. Ventilation Continuous positive airway pressure may be applied using a face mask; this has been shown to improve symptoms more quickly than oxygen therapy alone, and has been shown to reduce the risk of death. Severe respiratory failure requires treatment with endotracheal intubation and mechanical ventilation. Ultrafiltration Ultrafiltration can be used to remove fluids in people with<unk>  associated with kidney failure. Studies have found that it decreases<unk> h care utilization at 90 days. Surgery Certain scenarios will require emergent consultation with cardiothoracic surgery.<unk>  failure due to acute aortic regurgitation is a surgical emergency associated with high mortality.<unk>  failure may occur after rupture of ventricular aneurysm. These can form after myocardial infarction. If it ruptures on the free wall, it will cause cardiac tamponade. If it ruptures on the intraventricular septum, it can create a ventricular septal defect. Other causes of cardiac tamponade may also require surgical intervention, although emergent treatment at the bedside may be adequate. It should also be determined whether the patient had a history of a repaired congenital<unk>  disease as they often have complex cardiac anatomy with artificial grafts and shunts that may sustain damage, leading to<unk> . In some cases, doctors recommend surgery to treat the underlying problem that led to<unk>  failure. Different procedures are available depending on the level of necessity and include coronary artery bypass surgery,<unk>  valve repair or replacement, or<unk>  transplantation. During these procedures, devices such as<unk>  pumps, pacemakers, or defibrillators might be implanted. The treatment of<unk>  disease is rapidly changing and thus new therapies for acute<unk>  failure treatment are being introduced to save more lives from these massive attacks. Bypass surgery is performed by removing a vein from the arm or leg, or an artery from the chest and replacing the blocked artery in the<unk> . This allows the blood to flow more freely through the<unk> . Valve repair is where the valve that is causing<unk>  failure is modified by removing excess valve tissues that cause them to close too tightly. In some cases, annuloplasty is required to replace the ring around the valves. If the repair of the valve is not possible, it is replaced by an artificial<unk>  valve. The final step is<unk>  replacement. When severe<unk>  failure is present and medicines or other<unk>  procedures are not effective, the diseased<unk>  needs to be replaced. Another common procedure used to treat<unk>  failure patients is an angioplasty. Is a procedure used to improve the symptoms of coronary artery disease (CAD), reduce the damage to the<unk>  muscle after a<unk>  attack, and reduce the risk of death in some patients. This procedure is performed by placing a balloon in the<unk>  to open an artery that is blocked by atherosclerosis or a buildup of plaque on the artery walls. People who are experiencing<unk>  failure because of CAD or recent<unk>  attack can benefit from this procedure. A pacemaker is a small device that's placed in the chest or abdomen to help control abnormal<unk>  rhythms. They work by sending electric pulses to the<unk>  to prompt it to beat at a rate that is considered to be normal and are used to treat patients with arrhythmias. They can be used to treat<unk> s that are classified as either a tachycardia that beats too fast, or a bradycardia that beats too slow.
Acute decompensated heart failure
Acute exacerbation of chronic obstructive pulmonary disease
Acute pericarditis
Acute chest syndrome
Adrenal crisis
Acute liver failure
Uremic pericarditis
Swimming-induced pulmonary edema