Endotracheal intubation and mechanical ventilation should be carried out if the patient has a decreasing level of consciousness, respiratory failure, or acidosis and acidemia. Oxygen should be provided in high concentrations to prevent ongong hypoxia. An intravenous line and cardiac rhythm monitoring should be established. See Table 2 for examples of drugs used in managing acute congestive heart failure. Vasodilators are useful first-line agents in the management of CHF and pulmonary edema.
Nitrates decrease pulmonary vascular pressures by venodilation.
Nitroprusside provides arterial dilatation in addition to venodilation and is very useful in situations where hypertension accompanies pulmonary edema. Profound hypotension and headaches are the most common side effects of the vasodilators. They are useful in improving left ventricular dysfunction in the acute situation as well as managing hypertension in the long term. This class of drugs includes captopril, enalapril, lisonopril, and other similar newer agents. They all have multifactorial mechanisms of action.