Nitroglycerin vs. Furosemide Using Lung Ultrasound Pilot Trial (N-FURIOUS)
Heart Failure, Heart Failure Acute, Acute Cardiac Failure
About this trial
This is an interventional treatment trial for Heart Failure focused on measuring Heart Failure, Acute Heart Failure, Pulmonary Edema, Lung Ultrasound, Extra vascular lung water, B-lines, Diuretics, Nitrates
Eligibility Criteria
Inclusion Criteria:
- Age ≥ 21 years
- Presents with shortness of breath at rest or with minimal exertion
- Clinical diagnosis of AHF and presence of > 15 total bilateral B-lines distributed in at least 4 zones on initial LUS
- Hx of chronic HF and ANY ONE OF THE FOLLOWING:
- [Chest radiograph consistent with AHF
- Jugular venous distension
- Pulmonary rales on auscultation
- Lower extremity edema
- BNP > 500pg/mL]
Exclusion Criteria:
- Chronic renal dysfunction, including ESRD or eGFR < 20 ml//min/1.73m2.
- Shock of any kind. Any requirement for vasopressors or inotropes.
- SBP < 120
- Need for immediate intubation
- Acute Coronary Syndrome OR new ST-segment elevation/depression on EKG. (troponin release outside of ACS is allowed)
- Fever >101.5ºF
- End stage HF: transplant list, ventricular assist device
- Anemia requiring transfusion
- Known interstitial lung disease
- Suspected acute lung injury or acute respiratory distress syndrome (ARDS)
- Pregnant or recently pregnant within the last 6 months
- Severe valvular disease
- Anuria
- Allergy or hypersensitivity to nitroglycerin, furosemide or sulfa
- Concern for cardiac tamponade or restrictive cardiomyopathy
- Elevated intracranial pressure
- Recent use of PDE5 inhibitors
Sites / Locations
- Eskenazi Health
- IU Health Methodist Hospital
- Vanderbilt University
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Nitrate Intense Strategy
Diuretic Intense Strategy
Patients randomized to the Nitrate intense strategy will be treated according to protocol with nitrates in combination with IV loop diuretics. This protocol only involves therapies used in everyday AHF clinical practice.
Patients randomized to the Diuretic intense strategy will be treated according to protocol with IV loop diuretics in combination with nitrates. This protocol only involves therapies used in everyday AHF clinical practice.