(p. 709) Therapeutic strategy in cardiac failure 

The fundamental therapeutic principles of heart failure management are for acute heart failure with mainly signs of pulmonary congestion, normal or high blood pressure, and no signs of low cardiac output to reduce pulmonary congestion without affecting blood pressure. Management principles of cardiogenic shock management comprise improvement of forward flow with restoration/maintenance of adequate organ perfusion. Appropriate management requires sound appreciation of the underlying pathophysiology, awareness of the actions and potential side-effects of each therapeutic intervention, and a level of monitoring and investigation sophisticated enough to assess disease severity, and the effectiveness (or otherwise) of any treatment being given. Where possible, consideration of previous comorbidity factors and chronic symptomatology should guide how aggressive intervention should be. However, these must be based on documented fact, rather than hearsay or supposition. The patient should always be given the benefit of the doubt.