1/ #tweetorial
💠 Aggresive Nitroglycerin Usage in Acute Decompensated Heart Failure (ADHF)
➡️ Diuretics should not be considered first-line therapy in the ED treatment of patients with ADHF.
manualofmedicine.com/topics/cardiol…
#medtwitter #meded #foamed #cardioed #CardioTwitter
💠 Aggresive Nitroglycerin Usage in Acute Decompensated Heart Failure (ADHF)
➡️ Diuretics should not be considered first-line therapy in the ED treatment of patients with ADHF.
manualofmedicine.com/topics/cardiol…
#medtwitter #meded #foamed #cardioed #CardioTwitter
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➡️ The majority of ED patients who present with ADHF are not volume overloaded. Rather, their pulmonary congestion is due to volume redistribution.
➡️ High-dose nitroglycerin therapy should be initiated early in ADHF, especially in patients who are hypertensive.
➡️ The majority of ED patients who present with ADHF are not volume overloaded. Rather, their pulmonary congestion is due to volume redistribution.
➡️ High-dose nitroglycerin therapy should be initiated early in ADHF, especially in patients who are hypertensive.
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➡️ Often, these patients arrive to the ED by ambulance and receive sublingual nitroglycerin therapy (0.4 mg every 5 minutes) during their transport.
➡️ Do not begin a nitroglycerin infusion at a dose less than that provided by the sublingual route.
➡️ Often, these patients arrive to the ED by ambulance and receive sublingual nitroglycerin therapy (0.4 mg every 5 minutes) during their transport.
➡️ Do not begin a nitroglycerin infusion at a dose less than that provided by the sublingual route.
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➡️ Nitroglycerin doses of at least 120 mcg/min are needed to reduce capillary wedge pressure.
➡️ The nitroglycerin infusion can be rapidly increased to 400 mcg/min based upon clinical effect and patient symptoms.
➡️ Nitroglycerin doses of at least 120 mcg/min are needed to reduce capillary wedge pressure.
➡️ The nitroglycerin infusion can be rapidly increased to 400 mcg/min based upon clinical effect and patient symptoms.
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➡️ Noninvasive Ventilation (NIV) should be administered early and in conjunction with high-dose vasodilator therapy for AHDF.
➡️ Once the patient improves (decreased resp rate, decreased dyspnea, improved oxygenation, improved BP), diuretic therapy can be considered.
➡️ Noninvasive Ventilation (NIV) should be administered early and in conjunction with high-dose vasodilator therapy for AHDF.
➡️ Once the patient improves (decreased resp rate, decreased dyspnea, improved oxygenation, improved BP), diuretic therapy can be considered.
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➡️ Importantly, diuretics require adequate renal perfusion in order to be effective. During the initial ED evaluation and management when patients are in extremis, renal perfusion is poor, and diuretics are ineffective.
➡️ Importantly, diuretics require adequate renal perfusion in order to be effective. During the initial ED evaluation and management when patients are in extremis, renal perfusion is poor, and diuretics are ineffective.
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