CHF and HTN

flaerman · Mar 3, 2008

Lasix can lower BP so maybe they wanted to see how the pressure responded to the Lasix dose, then decide on anti-hypertensive therapy. As far as NTG- was the pt having chest pain/pressure? That would be more an indication for NTG. Lasix and O2 use are more first line tx's for CHF.

flaerman

Nvr2Old · Mar 3, 2008

The Lasix will get rid of the fluid and thus lower the pressure.

onyx77 · Mar 4, 2008

BP is probably high from the FVO. Lasix is a diurectic and will decrease fluid volume thus lowering BP. Decreasing BP will not increase fluid volume (at least I've never heard of that happening). Simply vasodilating and decreasing resistance will do nothing for the FVO - which is what seems to be this pt's problem secondary to CHF. Nitro wouldn't be given unless pt is having chest pain.

deeDawntee, RN · Mar 4, 2008

Hello!
I have the following question: patient in ED is hypervolemic, with mild pulmonary and 2+ pitting edema (PMH for DM, HTN, A-fib, CHF) with B/P of 174/84. We gave him lasix,O2, etc. I was wondering, why nothing was administered for his high blood pressure. Will lowering his blood pressure increase his hypervolemia? I thought that decreasing resistance should decrease afterload and thus increase preload and lower edema. Also CHF tx should include vasodilators like NTG, and those were not given as well.
Can anyone help, plz?

Be careful in making generalizations about CHF treatment. There are right sided, left sided, systolic and diastolic failure, plus any combination of the above. It certainly is treatable, but there are many factors to consider. There are rarely 'text book' patients. It is usually multifactoral and complex to treat.

The first goal is to diurese the patient with fluid overload. If you were to treat the hypertension first you could likely take away the patient's ability to compensate for all that fluid and put them into crisis. (ie you could unload the heart too much and put too much strain on the heart by making it work harder.) Also, if you gave an antihypersive med, then diuresed them, they could go into hypotensive shock. Increasing preload would not lower edema since the fluid is still there. Also, does the pt's failure prevent it from being able to give contract more effectively? Nitro would be dangerous for all these reasons, unless the patient was having chest pain. Even then diuresis would still be one of the most essential steps.

Also, one must always consider the kidneys. Are they functioning? Always keep an eye on the creatinine. (and the potassium level with lasix).

Hey, but you are asking good questions! Keep asking, that is the best way to learn.

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