Table 3.

Current evidence-based therapies for acute heart failure syndrome (AHFS)

Drug or class	Evidence	Indication	Main adverse effects
Loop diuretics	Never evaluated in large-scale randomized clinical trials	AHFS to relieve congestion	Hypotension, electrolyte abnormalities, and worsening renal function
Vasodilators
nesiritide	Improves hemodynamics and reduces dyspnea, neutral survival benefit (Abraham et al. 2005)	AHFS to improve symptoms	Hypotension, potential of worsening renal function
nitrates	High-dose isosorbide dinitrate more effective than furosemide in controlling severe pulmonary edema (Cotter et al. 1998)	First-line therapy for AHFS with adequate blood pressure	Hypotension, headaches, development of nitrate tolerance
sodium nitroprusside	Favorable hemodynamic effects (Guiha et al. 1974), no data on survival benefit, may increase risk in post-MI patients (Cohn et al. 1982)	Severe AHFS, hypertensive crisis	Hypotension, cyanide toxicity, accumulation in renal insufficiency
Inotropes
dopamine/dobutamine	Shown to improve symptoms in small scale studies (Liang et al. 1984)	AHFS with hypotension and peripheral hypoperfusion	Tachyarrhythmias, may increase mortality
milrinone	No effect on duration of hospital stay or mortality (Cuffe et al. 2002)	AHFS refractory to diuretics and vasodilators with preserved blood pressure	Sustained hypotension and tachyarrhythmia
levosimendan	No mortality benefit, reduces symptoms (Cleland et al. 2007; Mebazaa et al. 2007)	AHFS	Increased rate of atrial fibrillation and ventricular tachycardia
Ultrafiltration	More weight reduction than loop diuretics (Costanzo et al. 2007)	AHFS resistant to diuretics, or cardiorenal syndrome	Invasive, loss of solutes, procedural complications

MI, myocardial infarction.