Updates in pharmacological and non- pharmacological treatment of acute left ventricular failure

Abstract

The clinical syndrome of acute left ventricular failure may be present as de novo acute heart failure or as decompensated chronic heart failure. A patient with acute heart failure requires immediate diagnostic evaluation and care, and frequent resuscitative measure to improve symptoms and survival. Initial diagnostic assessment should include clinical examination supported by the patient history, ECG, chest X-ray. Echocardiography should be performed in all patients as soon as possible (unless recently done and the result is available). The initial clinical assessment should include evaluation of pre-load, after-load, and the presence of mitral regurgitation and other complicating disorders (including valvular complications, arrhythmias, concomitant co-morbidities such as diabetes mellitus, respiratory, renal diseases). Acute coronary syndromes are a frequent cause of acute left ventricular failure. Following the initial assessment, an intravenous line should be inserted and physical signs, ECG and oxygen saturation should be monitored. An arterial line should be inserted when needed. Routine use of invasive hemodynamic monitoring in patients with acute heart failure is not recommended. However, invasive hemodynamic monitoring is indicated in patients who are in respiratory distress or have clinical evidence of hypoperfusion in whom clinical assessment cannot adequately determine intracardiac filling pressures. Treatment goals for patients admitted with acute left ventricular failure include improving symptoms, optimizing volume status, identifying etiology and precipitating factors (particularly ischemia), initiating and optimizing oral therapy, minimizing side effects, educating patients, and considering a disease management program. The initial treatment of acute left ventricular failure started with pharmacological treatment as oxygenation with face mask or by non-invasive ventilation (oxygen saturation more than 92%).vasodilation by nitrate or nitroprusside, diuretic therapy by furosemide or loop diuretic, morphine for relief physical and psychological distress and to improve hemodynamics, vasopressors and inotropes if cardiogenic shock developed. The aim of the therapy is to correct hypoxia and increase cardiac output, renal perfusion, sodium excretion, and urine output.