For a patient with heart failure with preserved ejection fraction (HFpEF), what is the best initial management plan for acute decompensated heart failure?

In managing acute decompensated heart failure in a patient with preserved ejection fraction (HFpEF), the primary goal is to relieve symptoms of fluid overload, which often presents as dyspnea or orthopnea. Furosemide, a loop diuretic, is commonly used to effectively promote diuresis, thereby reducing elevated intravascular volume and alleviating congestion within the pulmonary and systemic circulation.

Furosemide is often the first choice in acute settings due to its rapid onset of action, particularly when administered intravenously. The dosing in this scenario is tailored to manage acute symptoms effectively; starting with an intravenous infusion allows for immediate adjustment based on the patient's response.

In contrast, while other options may also involve diuretic therapy or vasodilators, they do not represent the standard initial approach for rapid management of fluid overload as effectively as furosemide does in many clinical situations. For instance, nitroglycerin is primarily effective for managing chest pain and can help with preload reduction, but it is less directly associated with volume status. Torsemide and bumetanide, while effective diuretics, might not be the preferred choices for immediate acute management when compared to furosemide's established role