Congestive Heart Failure: Managing the Decompensated Patient

Learning Objectives

• 1Explain the neurohormonal cascade driving CHF decompensation — RAAS activation, sympathetic overdrive, ADH-mediated water retention, and natriuretic peptide counter-regulation — and identify the pharmacologic targets of each drug class in quad therapy
• 2Execute the acute CHF stabilization protocol including oxygen delivery selection, IV furosemide bolus dosing (2-4 mg/kg) and CRI calculation, butorphanol sedation, and contraindicated interventions (alpha-2 agonists, IV fluids)
• 3Construct the Stage C quad therapy protocol (furosemide, pimobendan, ACE inhibitor, spironolactone) using QUEST, BENCH, IMPROVE, and Bernay et al. trial evidence, and implement a structured furosemide escalation pathway for Stage D
• 4Manage Stage D refractory CHF using torasemide conversion (1:10-1:20 furosemide ratio), sequential nephron blockade with hydrochlorothiazide, and secondary pulmonary hypertension with sildenafil
• 5Apply a structured quality-of-life assessment framework, implement proactive end-of-life conversations at Stage C diagnosis, and counsel owners on home resting respiratory rate monitoring as an early decompensation detection tool

Course Syllabus

1. 1
   Meet Charlie — When a Stable Heart CrashesPreview

   module-1-meet-charlie

   7 min
2. 2
   The Neurohormonal Storm — Why Compensated Hearts Fail

   module-2-pathophysiology-decompensation

   9 min
3. 3
   Acute Stabilization — The First Golden Hour

   module-3-acute-stabilization

   10 min