Acute care
  • Oxygen inhalation.
  • Propped up position
  • Sublingual nitroglycerin and IV NTG if BP is high
  • IV furosemide 40-80 mg IV , repeat if needed.
  • Inotropes in hypotension.
  • Non invasive ventilation.
Salt and water restriction
  • 2gm salt, one litre of fluid / day.
Diueretics
  • Best option - furosemide + spironola tone.
Vasodilator ACE inhibitors or ARBs
  • T enalapril 2.5 mg BD increase upto 10 mg TID.
  • T losartan 25- 50 mg OD
Beta blockers ( metoprolol, carvedilol)
  • These drug can improve symptoms , start with low dose then slowly increase
Digoxin
  • Indicated in cardiac failure associated with atrial fibrillation.
  • Tab digoxin 0.125- 0 .25 mg OD five days in a week.
Inotropic support
  • Dobutamine 2.5 - 15 mcg /kg/min infusion
  • Dopamine 2- 8 mcg /kg/ min infusion
Intra aortic balloon pumping
  • It consists of a cylindrical poly ethylene balloon that sits in aorta and counter pulsates