Initial management of acute decompensated heart failure typically includes which approach?

• A. Diuresis and vasodilation
• B. Calcium channel blockers
• C. Arterial vasoconstrictors
• D. Inotropic support only

Answer: (A)

Acute decompensated heart failure is treated first by unloading the congested ventricle and reducing filling pressures through diuresis and vasodilation. Diuretics rapidly remove excess fluid, lowering preload and easing pulmonary edema. Vasodilators decrease both preload and afterload, which reduces venous return and systemic vascular resistance, improving forward flow and oxygenation. Together, these approaches relieve dyspnea and pulmonary congestion and stabilize hemodynamics. Calcium channel blockers are not used in this setting because they can dampen contractility and worsen hypotension. Arterial vasoconstrictors would raise afterload and worsen congestion, so they aren’t initial therapy. Inotropes are considered only if there is evidence of poor perfusion or shock, not as the default first step.