Re: Hypotension and antihypertensive meds
I would have given the Coreg, not the Imdur when the BP stabilized. It's the whole beat-blockade/reduced workload-thing that we're working towards with chronic HFers. We're trying to maximize the ability of the heart while minimizing the workload - make it work more efficiently. That's probably why the FP was ******.
Other than that, I think the intervention matched the issue. Yes, maybe a 500ml bolus may have put the patient into worse HF, but when they are hypotensive AND symptomatic you have to do something and a bolus is a good way to fill the pump.
You'll find that our HFers are better able to handle their meds, especially the "cocktail" (beta-blocker, ACEI, diuretic) combo that many are on and are functional at lower BPs than most. In many cases with these folks I see parameters around 80-90 SBP to hold, many times that's where they live.
Chalk it up to a learning experience.
Cheers,
Tom
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