Managing Septic Shock in Patients with a Broken Heart: Focus on Hemodynamic Management with Fluids and Vasoactive Agents

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Currently, national guidelines do not address sepsis management in patients with underlying heart failure with reduced ejection fraction (HFrEF). Several factors make the management of sepsis in patients with HFrEF uniquely challenging, including a heightened risk of volume overload and the need for alternative vasoactive regimens to maintain cardiac output. The purpose of this blog is to provide practical considerations in the hemodynamic management of septic patients with HFrEF using fluids and vasoactive agents.

Can beta-blockers be continued in patients requiring inotropic therapy?

Although beta blockers are considered a fundamental therapy for patients with heart failure (HF), questions remain on how to manage them these medications in patients presenting with decompensation requiring intravenous inotropic therapy. In this post, we will provide some insights on managing the chronic beta blockade and intravenous inotropic therapy when used concomitantly in a decompensated HF patient.

Propofol-Induced Myocardial Depression: Does This Really Exist?

In the intensive care setting, propofol is a commonly used medication for management of sedation in mechanically ventilated, critically ill patients. However, intensivists often select dexmedetomidine over propofol in patients with cardiovascular disease due to concern for cardiac adverse effects such as myocardial depression. In this blog, I’ll be discussing three important considerations before accepting propofol-induced myocardial depression as clinically significant.

Muddying the Water: Reduced vs. Preserved Ejection Fraction in Trials of Acute Decompensated Heart Failure

Evidence from randomized controlled trials has demonstrated that the cornerstone pharmacologic therapies used in the management of chronic heart failure with reduced ejection fraction (HFrEF) do not confer the same benefits in patients with preserved ejection fraction (HFpEF). So why do we enroll both subgroups in trials of acute decompensated heart failure (ADHF)? In this entry, we’ll explore differences in pathophysiology between HFrEF and HFpEF and how they may result in variable responses to pharmacologic therapies commonly used in ADHF, particularly diuretics and vasodilators.

Which Patients with Heart Failure Should Get Loop Diuretics as a Continuous Infusion? (Part 1)

In the Diuretic Optimization Strategies Evaluation (DOSE) trial, intravenous boluses of loop diuretics were shown to as efficacious and safe as continuous infusions in patients with acute decompensated heart failure. However, the heterogeneity of the population enrolled in DOSE makes it difficult to identify patient populations who might actually benefit from one strategy over another. In Part 1 of this two-part series, we’ll explore several potential populations in whom continuous infusions may be beneficial over intermittent boluses.