Decrease metabolic need. Oxygen demand supply ratio: Bed rest, Oxygen, decrease catecholamine activity (Beta-blockers)
To reduce venous return (pre-load): Elevate head end of bed, Nitrates, Diuretics (Furosemide) (Old tricks: Alternating tourniquet, Phlebotomy)
Increase cardiac output: Inotropic agents: dopamine, dobutamine, amrinone, milrinone, digoxin (chronic chf) nitropress,
Reduce work load: Reduce after-load: , Peripheral vascular resistance. Arterial dilatation (Nitrates, nitropress) IABP
Underlying cause: Diastolic dysfunction (reduce blood pressure) Replacing stenotic valve.
Eliminate contributing factors: Anemia
Counter deleterious compensatory efforts: Rennin agiotensin system. Salt and water restriction, ACE inhibitors (Captopril, Enalpril)
Analgesics and Anxiolytic: Morphine (Pulmonary edema)
Cardiac Transplantation: Last resort to a completely failed Heart refractory to therapy.
Mechanical ventilation: In severe cases of pulmonary edema. To support ventilation. Provide rest to Myocardium. To control pulmonary edema.
Dialysis: Combined Renal and Heart failure