Nesiritide (Natrecor) is a medication used to treat acutely decompensated heart failure.

• A. Dopamine
• B. Dobutamine
• C. Furosemide
• D. Nesiritide (Natrecor)

Answer: (D)

In acutely decompensated heart failure, rapidly reducing filling pressures and systemic vascular resistance to relieve congestion is a primary goal. Nesiritide is a recombinant B-type natriuretic peptide given by IV infusion that causes venous and arterial dilation. This vasodilation lowers preload and afterload, decreases pulmonary congestion, and often improves dyspnea and oxygenation quickly. It’s used specifically for symptomatic relief in ADHF when there is evidence of elevated filling pressures and the patient needs vasodilator therapy.

Dopamine and dobutamine are inotropes/vasopressors chosen to boost cardiac output in low-output states, but they don’t directly address elevated filling pressures and can increase myocardial oxygen demand. Furosemide is a potent diuretic that reduces fluid overload, but it doesn’t provide the rapid vasodilation and pressure relief that Nesiritide offers. Therefore Nesiritide is the best fit for treating acutely decompensated heart failure in this context, with the caveat to monitor for hypotension and renal effects.