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

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

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)

• 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)