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Acute Decompensated Heart Failure Jo E. Rodgers and Brent N. Reed LEARNING OBJECTIVES 15 On completion of the chapter, the reader will be able to: 1 Discuss the epidemiology of acute decompensated heart failure, including its prevalence and impact on healthcare expenditures. 2 List common precipitating factors for acute decompensated heart failure as well as baseline predictors of morbidity and mortality. 3 Compare and contrast the signs and symptoms of acute decompensated heart failure due to volume overload versus low cardiac output. 4 Determine the appropriate management of oral heart failure medications taken prior to admission for a patient being hospitalized with acute decompensated heart failure. 5 Devise a management plan for volume overload in a patient exhibiting diuretic resistance. Explain potential underlying etiologies of diuretic resistance, and the mechanism by which the selected treatment approach will overcome it. 6 Compare and contrast the use of nesiritide, nitroglycerin, and sodium nitroprusside in the management of acute decompensated heart failure. 7 Compare and contrast the use of dobutamine and milrinone in the management of acute decompensated heart failure. 8 Design a pharmacotherapy regimen for a patient with acute decompensated heart failure based on clinical presentation and/or hemodynamic parameters. 9 Describe the role of advanced cardiovascular therapies in patients with refractory acute decompensated heart failure, including temporary and durable mechanical circulatory support and cardiac transplantation. 10 Devise a plan, including recommendations for medication therapy, education, and monitoring, for a patient being discharged after an episode of acute decompensated heart failure.