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