Complications

Your Organisational Guidance

ebpracticenet urges you to prioritise the following organisational guidance:

Behandeling acuut cardiogeen longoedeem in een urgente situatie (in afwachting van hospitalisatie)Published by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2022La prise en charge de l’oedème pulmonaire aigu cardiogénique en situation d'urgence (en attente d'une hospitalisation)Published by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2022
Complication
Timeframe
Likelihood
short term
high

Acute heart failure is frequently precipitated by arrhythmias (in particular, atrial fibrillation), but acute heart failure may also cause arrhythmias.[60][61]

Overview of dysrhythmias (cardiac)

short term
high

Commonly causes headache and hypotension. The headache is usually mild to moderate in severity and either resolves or diminishes in intensity with continued nitrate therapy. If hypotension occurs then the infusion rate should be decreased. If hypotension persists then the infusion should be discontinued and restarted when the patient is haemodynamically stable.

short term
high

Causes headache and hypotension. If hypotension occurs, then the infusion rate should be decreased. If hypotension persists, then the infusion should be discontinued and restarted when the patient is haemodynamically stable.

short term
medium

Over-diuresis leads to worsening of renal function, hypotension, and hypokalaemia, and also activation of neurohormones including renin-angiotensin system and the sympathetic system. It may potentiate the toxicity of other agents like digoxin, either by causing hypokalaemia or by decreasing the glomerular filtration.

In cases of worsening renal impairment due to over-diuresis, the dose of diuretics should be decreased. In case of severe renal impairment the diuretic can be withheld and the patients assessed daily, with re-introduction of diuretic at lower doses.

short term
medium

Dobutamine and milrinone can cause arrhythmias and worsening of coronary ischaemia.

The occurrence of sustained arrhythmias should lead to discontinuation. In cases where these medications are absolutely needed, concomitant use of amiodarone may be advisable, although there are no large-scale data on the use of anti-arrhythmics in this setting. If the patient has symptomatic coronary ischaemia, these infusions should be discontinued.

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