Heart Failure

• 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

Acute Heart Failure

• Rapid onset of or change in the signs and symptoms of heart failure
• Arises as a result of deterioration in patients previously diagnosed with heart failure or may also be the first presentation of heart failure
• 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 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

• 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)
• Cardiac tamponade
• Acute pulmonary embolism
• Hypertensive crisis or uncontrolled hypertension
• Aortic dissection
• Surgery and perioperative problems
• Peripartum cardiomyopathy
• Infection (eg infective endocarditis)
• Chronic obstructive pulmonary disease (COPD) or asthma exacerbation
• Anemia
• Renal dysfunction
• Hypothyroidism or hyperthyroidism
• Noncompliance to diet or drug therapy
• Iatrogenic causes (eg non-steroidal anti-inflammatory drugs, corticosteroids, drug interactions)
• High output 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
  • 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 heart failure include elevated jugular venous pressure, hepatojugular reflux, apical impulse that is laterally displaced, and presence of S3 (gallop rhythm)