Heart%20failure%20-%20acute Signs and Symptoms

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

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 noncompliance 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

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 
• Noncompliance 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)  

• 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)