Congestive Heart Failure

Emerg Med Clin North Am. 2015 Aug;33(3):553-62. doi: 10.1016/j.emc.2015.04.006. Epub 2015 Jun 10.


Patients with acute decompensated heart failure are usually critically ill and require immediate treatment. However, most are not volume overloaded. Emergency department (ED) management is based on rapid initiation of noninvasive positive-pressure ventilation and aggressive titration of nitrates. Afterload reduction with an angiotensin-converting enzyme inhibitor can be considered. A diuretic should not be administered before optimal preload and afterload reduction has been achieved. Short-term inotropic therapy can be considered in select patients with cardiogenic shock and acute decompensated heart failure (ADHF) who fail to respond to standard therapy.

Keywords: Acute decompensated heart failure; Angiotensin converting enzyme inhibitors; Congestive heart failure; Diuretics; Inotropes; Nitrates; Noninvasive positive pressure ventilation.

Publication types

  • Review

MeSH terms

  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Cardiotonic Agents / therapeutic use
  • Diuretics / therapeutic use
  • Emergency Service, Hospital*
  • Heart Failure / diagnosis*
  • Heart Failure / etiology
  • Heart Failure / therapy*
  • Humans
  • Positive-Pressure Respiration
  • Vasodilator Agents / therapeutic use


  • Angiotensin-Converting Enzyme Inhibitors
  • Cardiotonic Agents
  • Diuretics
  • Vasodilator Agents