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Congestive Heart Failure, Emergency Medicine

Reviewed 06/2017



  • A clinical syndrome in which the heart fails to maintain adequate circulation for metabolic needs, characterized by chronic debility, acute decompensation, and high mortality.

  • Acute D...


Signs and Symptoms

  • Poor perfusion:

    • Fatigue, somnolence, lightheadedness

    • Palpitations, or irregular pulse

    • Shortness of breath

    • Cool extremities

    • Worsening renal function

  • Congestion

    • Dyspnea, cough

    • Orthop...



  • IV access

  • Supplemental oxygen

  • Cardiac monitor and pulse oximetry

  • EKG

  • Sublingual nitrates for active chest pain without hypotension

  • Furosemide

  • Endotracheal intubation may be required.

Initial Stabilization/Therapy



Admission Criteria

  • ICU:

    • Pulmonary edema

    • Cardiogenic shock

    • Concomitant MI or ischemia

  • Medical wards:

    • New-onset CHF

    • Symptoms not relieved by ED therapy

Discharge Criteria

  • Mild exacerbation o...

Pearls and Pitfalls

  • BNP may be useful if CHF diagnosis uncertain.

  • In severe CHF, NIPPV can improve impending respiratory compromise.

  • Be vigilant in searching for and treating the underlying cause of the...

Additional Reading

  • Heart Failure Society of America. Executive summary: HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail.  2010;16(6):475–535.

  • Singer  AJ, Birkhahn  RH, Guss  ...



  • 428.0 Congestive heart failure, unspecified

  • 428.20 Systolic heart failure, unspecified

  • 428.30 Diastolic heart failure, unspecified

  • 428.40 Combined systolic and diastolic heart failure, unspecif...

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