First Things First (assess & treat for the following)

• Is there evidence for isolated systolic dysfunction?
  • LV ejection fraction < 50%
• Is there evidence for isolated diastolic dysfunction?
  • Ejection fraction >50%, but
  • Impaired ventricular filling on echocardiography
• Signs of heart failure/cardiogenic shock? (i.e., low/“inadequate” cardiac output)
  • Heart failure is a clinical diagnosis (symptoms and signs).
  • Treat reversible causes (tamponade, coronary ischemia, pulmonary embolism, thyrotoxicosis, severe anemia, etc.).
  • Optimize cardiac output and treat symptoms.
    • Inotropic support (drugs, assist devices, etc.)
    • Vasodilator therapy and/or afterload reduction
    • Diuresis as tolerated