PHARMACOLOGICAL TREATMENTS OF ACUTE DECOMPENSATED HEART FAILURE (ADHF)

Abstract

Acute decompensated heart failure (ADHF) is a complex and heterogeneous condition requiring rapid assessment and individualized pharmacological treatment based on congestion, blood pressure, perfusion, and renal function. Intravenous loop diuretics remain the cornerstone of therapy for relieving fluid overload, with thiazide-type diuretics used when additional decongestion is required. Vasodilators, such as nitrates and sodium nitroprusside, may be used selectively in patients with adequate or elevated blood pressure to reduce preload and/or afterload. Inotropes and vasopressors are generally reserved for severe hypoperfusion, hypotension, or cardiogenic shock because of their potential adverse effects. Disease-modifying heart failure therapies, including ACE inhibitors/ARBs, ARNIs, beta-blockers, MRAs, and SGLT2 inhibitors, should be continued or initiated when clinically appropriate after hemodynamic stabilization. Overall, effective ADHF management requires a patient-specific, hemodynamic-guided approach that balances rapid decongestion and stabilization with the early establishment of long-term guideline-directed therapy.