heart%20failure%20-%20acute
HEART FAILURE - ACUTE
Heart failure is a clinical syndrome caused by cardiac dysfunction usually secondary to myocardial muscle loss or dysfunction.
It is characterized by either left ventricular hypertrophy or dilation or both.
It leads to neurohormonal and circulatory abnormalities.
Acute heart failure is the rapid onset of or change in the signs and symptoms of heart failure.
It arises as a result of deterioration in patients previously diagnosed with heart failure or may also be the first presentation of heart failure.
It is characterized by pulmonary congestion, decreased cardiac output and tissue perfusion.
It is a life-threatening condition that needs immediate medical attention.

Introduction

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

Definition

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

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)
  • 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

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 heart failure include elevated jugular venous pressure, hepatojugular reflux, apical impulse that is laterally displaced, and presence of S3 (gallop rhythm)
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Cardiology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
24 Dec 2017
Losartan at 50 mg is effective in reducing blood pressure in patients with postdialysis euvolemic hypertension, a recent study has shown.
29 Dec 2017
Preoperative hyponatraemia and higher body mass index (BMI) before surgery increase the risk of postoperative stress-related cardiomyopathy (SRC), according to a recent study.
24 Dec 2017
Cardiovascular (CV) diseases or CV risk factors account for the reduced quality of life (QOL) in diabetics compared with nondiabetics, a recent study has found.
24 Dec 2017
The CENTERA transcatheter heart valve (THV) has been proven safe and effective in high-surgical-risk patients with severe symptomatic aortic stenosis at 30 days, resulting in low mortality, significant improvements in haemodynamic outcomes, and low incidence of adverse events, according to a study.