Acute Heart Failure

Abstract

Acute heart failure is defined as a rapid onset of worsening of symptoms and/or signs of heart failure such as dyspnoea, orthopnoea, peripheral oedema up to cardiogenic shock, and acute cardiac death. It may be an acute condition, but more commonly a consequence of acute decompensation of chronic heart failure. Acute heart failure is often precipitated by acute myocardial ischaemia, infection, hypertension, arrhythmia, drugs, and toxins, as well as non-compliance with heart failure drugs. The clinical examination reveals peripheral oedema, pulmonary rales, extended jugular veins, third heart sounds, and mitral and/or aortic regurgitation or stenosis. Laboratory findings show elevated levels of natriuretic peptides and often, also, troponins, while chest X-ray reveals pulmonary congestion and echocardiography reduced left ventricular ejection fraction and/or valvular heart disease. The therapeutic strategy differs on whether the patient has congestion or suffers mainly from impaired organ perfusion. As such, patients may be warm and dry, warm and wet, cold and dry, or cold and wet. Depending on these clinical features intravenous vasodilators or vasoconstrictors or diuretics may be the appropriate treatment option. In severe cases, left ventricular assist devices may be considered.

Topics & Concepts