Much has been written about the management of chronic heart failure (HF) and there is strong evidence from many controlled, multicenter trials to support a specific strategy for management of compensated HF. There is little evidence and limited guidance for the management of patients during a period of decompensation. The use of diuretics, inodilators, and vasodilators is based primarily on anecdotal observation. This article reviews selected current literature in three areas (diuretics, vasodilators, and inotropes) to examine objective evidence and expert opinion that are available to guide the advanced practitioner who manages the care of patients with decompensated HF.

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