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

Signs and Symptoms

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 onset of or change in the signs and symptoms of heart failure
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
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

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 [nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, cardiotoxic chemotherapeutics, negative inotropic agents]
High output states (eg severe anemia, thyrotoxicosis)
Fluid overload (eg renal failure, iatrogenic causes)

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, tachycardia, apical impulse that is laterally displaced and presence of S3 (gallop rhythm)

Empagliflozin’s clinical endorsement: Revolutionising guidelines across specialties

08 Jun 2020

In this third issue we take a look at how empagliflozin made a bold impact on clinical guidelines across multiple specialties. We will explore how existing treatment recommendations were altered, and summarise the current guidelines and future perspectives of empagliflozin’s use.

Nebivolol associated with reduced CV risk in hypertension and CHF

Prof. Michael Weber, Prof. Giuseppe Mancia, Dr. Nelson Abelardo, 08 Nov 2016

The use of beta-blockers in patients with cardiovascular (CV) disorders is somewhat controversial. However, many of the problems associated with traditional first- and second-generation beta-blockers may not be applicable to third-generation beta-blockers. Professor Michael Weber from the State University of New York, US, Professor Giuseppe Mancia from the University of Milano-Bicocca, Italy, and Dr Nelson Abelardo from the University of the Philippines, discussed the role of beta-blockers in managing patients with hypertension and chronic heart failure (CHF) at a recent Menarini-sponsored symposium held during the International Society of Hypertension 2016 meeting in Seoul, Korea, highlighting the potential benefits associated with newer beta-blockers such as nebivolol (Nebilet^®, Menarini).

ACE inhibitor-based combination therapy important for improving BP control in the Asia Pacific region

Prof. Abdul Rashid, Prof. Martin Strauss, Prof. Alistair Hall, 12 Dec 2016

Hypertension is a leading cause of mortality globally and is of particular concern in the Asia Pacific region where there are more deaths due to poor blood pressure (BP) control than in any other region in the world. At a recent Servier-sponsored satellite symposium held during the ASEAN Federation of Cardiology Congress in Yangon, Myanmar, Professor Abdul Rashid, An Nur Specialist Hospital, Selangor, Malaysia, discussed the challenges associated with managing hypertension in the region. In addition, Professor Martin Strauss, North York General Hospital, Toronto, Canada and Professor Alistair Hall, Leeds General Infirmary, UK, discussed the different effects of angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on cardiovascular (CV) outcomes, highlighting the additional protection against myocardial infarction (MI) offered by ACE inhibitors such as perindopril.