Introduction
Heart Failure
- A clinical syndrome caused by functional or structural impairment of ventricular filling or blood ejection
- Characterized by either left ventricular hypertrophy or dilation or both
Definition
Acute Heart Failure
- Rapid or gradual onset of or change in the signs and/or symptoms of heart failure
- Arises as a result of acute cardiac function deterioration in patients previously diagnosed with heart failure or may also be the first presentation of heart failure
- Acute heart failure arising from decompensation of chronic heart failure is associated with arrhythmia, uncontrolled hypertension, infection and non-compliance with therapy and diet
- Cardiac dysfunction may be related to ischemia, arrhythmia, valvular abnormalities, pericardial disease, myocarditis, cardiomyopathy, increased filling pressure or elevated systemic resistance
- Characterized by pulmonary congestion, decreased cardiac output and tissue hypoperfusion
- Most acute heart failure patients present with normal or high blood pressure and signs and/or symptoms of congestion instead of low cardiac output
- Life-threatening condition that needs immediate medical attention
- May be transient and reversible with resolution of the acute syndrome or may induce permanent damage leading to chronic heart failure
Etiology
Causes of Acute Heart Failure
- Acute coronary syndrome or its complications (eg rupture of interventricular septum, mitral valve chordal rupture, right ventricular infarction, acute mitral regurgitation)
- Hypertensive crisis or uncontrolled hypertension
- Tachyarrhythmia (eg atrial fibrillation, ventricular tachycardia), severe bradycardia or conduction abnormalities
- Pulmonary embolism
- Infection (eg infective endocarditis, pneumonia, sepsis)
- Pericardial tamponade
- Aortic dissection
- Surgery and perioperative problems
- Peripartum or stress-related cardiomyopathy
- Chronic obstructive pulmonary disease (COPD) exacerbation
- Cerebrovascular insult
- Worsening renal failure
- Electrolyte disturbances
- Non-compliance to diet or drug therapy
- Medications (nonsteroidal anti-inflammatory drugs [NSAIDs], steroids, cardiotoxic chemotherapeutics, negative inotropic agents)
- High output states (eg severe anemia, thyrotoxicosis)
- Fluid overload (eg volume overload causing pulmonary edema in acute kidney injury, iatrogenic causes)
- Toxic substances (recreational drugs, alcohol)
Signs and Symptoms
- Heart failure leads to neurohormonal and circulatory abnormalities producing the following manifestations:
- Breathlessness/dyspnea at rest or on exertion
- Decreased exercise capacity or increased time to recover after exercise
- Unexplained fatigue, tiredness
- Orthopnea
- Bendopnea
- Paroxysmal nocturnal dyspnea (PND) or nocturnal cough
- Cough or wheezing
- Palpitations
- Anorexia, nausea, vomiting, abdominal pain, bloated feeling, early satiety, ascites
- Peripheral edema, ankle swelling
- Confusion, disorientation, cognitive decline
- Weakness, depression (especially in the elderly)
- Weight gain (>2 kg/week)
- Weight loss (in advanced heart failure)
- Syncope
- More specific signs typical of heart failure include elevated jugular venous pressure, hepatojugular reflux, apical impulse that is laterally displaced and presence of S3 (gallop rhythm)