Management of acute left ventricular failure

The principles of treating acute heart failure are presented below:

• lung function optimisation:
  • sit the patient up
  • administer maximal oxygen concentrations
    
    
• intravenous diuretic:
  • 40-80 mg frusemide
    
    
• intravenous opiate analgesia:
  • 5 mg diamorphine over 5 min
    
    
• treatment of arrhythmias:
  • may require DC cardioversion or intravenous anti- arrhythmic therapy
    
    
• vasodilator therapy
  
  
• digoxin:
  • cautious intravenous administration if the above fail
    
    
• venesection:
  • a pint may be removed from a moribund patient who fails to respond to the above
    
    
• inotropes:
  • dobutamine infusion
  • dopamine infusion

Topics specific to the treatment of acute right ventricular failure are discussed elsewhere.