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HEART FAILURE - ACUTE
Heart failure is a clinical syndrome caused by cardiac dysfunction usually secondary to myocardial muscle loss or dysfunction.
It is characterized by either left ventricular hypertrophy or dilation or both.
It leads to neurohormonal and circulatory abnormalities.
Acute heart failure is the rapid onset of or change in the signs and symptoms of heart failure.
It arises as a result of cardiac function deterioration in patients previously diagnosed with heart failure or may also be the first presentation of heart failure.
It is characterized by pulmonary congestion, decreased cardiac output and tissue perfusion.
It is a life-threatening condition that needs immediate medical attention.

Introduction

Heart Failure (HF)

  • A clinical syndrome caused by cardiac dysfunction usually secondary to myocardial muscle loss or dysfunction
  • Characterized by either left ventricular (LV) hypertrophy or dilation or both

Definition

Acute Heart Failure

  • Rapid onset of or change in the signs and symptoms of HF
  • Arises as a result of cardiac function deterioration in patients previously diagnosed with HF or may also be the first presentation of HF
  • Cardiac dysfunction may be related to ischemia, arrhythmia, valvular abnormalities, pericardial disease, increased filling pressure or elevated systemic resistance
  • Characterized by pulmonary congestion, decreased cardiac output and tissue hypoperfusion
    • Most acute HF 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 HF

Etiology

Causes of Acute Heart Failure

  • Rapid arrhythmia, severe bradycardia or conduction abnormalities
  • Acute coronary syndrome or its complications (eg rupture of interventricular septum, mitral valve chordal rupture, right ventricular infarction, acute mitral regurgitation)
  • Pericardial tamponade
  • Pulmonary embolism
  • Hypertensive crisis or uncontrolled hypertension
  • Aortic dissection
  • Surgery and perioperative problems
  • Peripartum cardiomyopathy
  • Infection (eg infective endocarditis, pneumonia)
  • Chronic obstructive pulmonary disease (COPD) exacerbation
  • Noncompliance to diet or drug therapy
  • Medications (NSAIDs, steroids, cardiotoxic chemotherapeutics, negative inotropic agents) 
  • High output states (eg severe anemia, thyrotoxicosis)
  • Fluid overload (eg renal failure, iatrogenic causes)

Signs and Symptoms

  • 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
    • Ankle swelling
    • Nausea, vomiting, abdominal pain, bloated feeling
    • Confusion, disorientation
    • Weakness, depression (especially in the elderly)
    • Weight gain (>2 kg/week)
    • Weight loss (in advanced heart failure)
    • Syncope
  • More specific signs typical of HF include elevated jugular venous pressure, hepatojugular reflux, apical impulse that is laterally displaced and presence of S3 (gallop rhythm)
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