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Treatment of acute decompensated heart failure in acute coronary syndromes

Author
Wilson S Colucci, MD
Section Editors
Stephen S Gottlieb, MD
James Hoekstra, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

Patients with acute decompensated heart failure (ADHF) often have coronary artery disease with or without an acute coronary syndrome [1]. The acute onset of severe myocardial ischemia can lead to a sudden impairment in systolic and diastolic function, resulting in a decreased cardiac output, elevated filling pressures, and the development of pulmonary edema. Flash pulmonary edema can result from myocardial ischemia with or without myocardial infarction (MI).

Specific considerations apply to treatment of ADHF in patients presenting with acute coronary syndromes. The recommendations presented here are generally in agreement with those published in the 2004 American College of Cardiology/American Heart Association (ACC/AHA) ST elevation MI guidelines with 2007 focused update, the 2007 ACC/AHA unstable angina/non-ST elevation MI guideline, and the 2009 focused update of the 2005 ACC/AHA HF guidelines [2-5].

Overall management of acute coronary syndrome and acute MI (including fuller discussion of all therapies including anticoagulant and antiplatelet agents), cardiogenic shock in the setting of acute MI, and general treatment of ADHF are discussed separately. (See "Overview of the acute management of ST elevation myocardial infarction" and "Overview of the acute management of unstable angina and non-ST elevation myocardial infarction" and "Prognosis and treatment of cardiogenic shock complicating acute myocardial infarction".)

Management of right ventricular MI which typically presents with hypotension and clear lungs is discussed separately (see "Right ventricular myocardial infarction").

REVASCULARIZATION

Urgent revascularization is a major component of therapy for patients presenting with ST elevation myocardial infarction (STEMI), and is particularly important for those with heart failure (HF). Early revascularization is indicated for patients presenting with unstable angina/non-ST elevation MI (UA/NSTEMI) and HF. As recommended in the 2009 focused update of the 2005 American College of Cardiology/American Heart Association HF guidelines, urgent cardiac catheterization and revascularization is reasonable when it is likely to prolong meaningful survival in patients with acute HF and known or suspected acute myocardial ischemia due to occlusive coronary disease, especially when there are signs and symptoms of systemic hypoperfusion [5]. (See "Overview of the acute management of ST elevation myocardial infarction" and "Overview of the acute management of unstable angina and non-ST elevation myocardial infarction" and "Coronary angiography and revascularization for unstable angina or non-ST elevation acute myocardial infarction" and "Acute ST elevation myocardial infarction: Selecting a reperfusion strategy".)

             

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Literature review current through: Nov 2016. | This topic last updated: Fri Apr 22 00:00:00 GMT+00:00 2016.
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References
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