5 Pearls on Inpatient Heart Failure

Core IM

Initial evaluation, workup, and management of acute decompensated heart failure can be complex.  Initial evaluation can often miss worrisome vital signs and common lab abnormalities such as hyponatremia are overlooked despite portending poor prognosis.  In this episode of Core IM, the team discusses treatment, complications from management, and more in 5 Pearls on Inpatient Heart Failure.

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Core IM

Welcome to Core IM, a virtual medical community! Core IM strives to empower its colleagues of all levels and backgrounds with clinically applicable information as well as inspire curiosity and critical thinking. Core IM promotes its mission through podcasts and other multimodal dialogues. ACP has teamed up with Core IM to offer continuing medical education, available exclusively to ACP members by completing the CME/MOC quiz.

Heart Failure (HF) exacerbation is a clinical syndrome (collection of signs and symptoms) due to elevated intracardiac filling pressures leading to vasoconstriction and/or volume retention. 

Pearl 1: Initial clinical assessment

  • Blood pressure: 
    • Hypotension is more common among HFrEF patients, and can be a sign of poor perfusion and even shock. 
    • Hypertension can cause someone to go into a heart failure exacerbation. Improve BP control with vasodilation/afterload reduction.
    • Narrow Pulse pressure is a sign of low output state:
  • Heart Rate: 
    • Tachycardia could be a sign of shock. However, the prevalence of beta-blockers can prevent the tachycardic response, so a normal heart rate does not rule out shock in a heart failure patient. 
  • Jugular venous distention/pulsation
  • Dry v Wet and Cold v Warm: This information helps determine need for volume removal and/or ionotropic support. 
    • Ideal HF patient is warm and dry. 
    • A “Wet” patient needs volume removal. 
    • A “Cold” patient is having poor perfusion and needs additional perfusion support. 

Pearl 2: Initial lab workup


Shreya Trivedi, MD - Host, Show Notes

Martin Fried, MD - Host, Show Notes

Michael Dunleavy, MD - Host, Show Notes, CME Questions

Swapnil Hiremath, MD, MPH - Guest Expert

Gregory Katz, MD - Guest Expert

Michelle Kittleson, MD, PhD - Guest Expert

Ayesha Hasan, MD - Guest Expert


Stephen Pan, MD*

Eugene Yuriditsky, MD

* Stephen Pan reports participating in speakers’ bureaus for Pfizer and Akcea

Those named above unless otherwise indicated have no relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.

Release Date: June 24, 2020

Expiration Date: June 24, 2023

CME Credit

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American College of Physicians and the Core IM.  The American College of Physicians is accredited by the ACCME to provide continuing medical education for physicians.

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