Acute heart failure

Acute heart failure is a clinical syndrome of reduced cardiac output, tissue hypoperfusion, increased pulmonary pressure, and tissue congestion.

Presents with dyspnea, decreased exercise tolerance, swelling of the legs, fatigue, and generalized weakness.

Clinical diagnosis is supported by ancillary tests such as ECG, chest x-ray, B-type natriuretic peptide, and echocardiogram. In cases where echocardiographic images are suboptimal or when an unusual cause of heart failure is suspected, and for diagnosis of specific cardiomyopathies, other tests (e.g., cardiac catheterization with hemodynamic measurements, computed tomography, and cardiac magnetic resonance imaging) are used.

Diuretics, oxygen, and vasodilators are initial treatments for symptom relief. Cardiogenic shock may require vasoactive agents, mechanical ventilation, or mechanical circulatory support.

If acute myocardial infarction is present, early revascularization is essential.

Underlying cause or precipitant should be identified and treated.

Heart failure is defined clinically as a syndrome in which patients have symptoms and signs resulting from an abnormality of cardiac structure and/or function causing impairment of ventricular filling or ejection of blood.[1]McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-726. https://academic.oup.com/eurheartj/article/42/36/3599/6358045 http://www.ncbi.nlm.nih.gov/pubmed/34447992?tool=bestpractice.com [2]Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 May 3;145(18):e895-1032. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001063 http://www.ncbi.nlm.nih.gov/pubmed/35363499?tool=bestpractice.com  Acute heart failure refers to rapid onset or worsening of symptoms and/or signs of heart failure, requiring urgent evaluation and treatment.[1]McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-726. https://academic.oup.com/eurheartj/article/42/36/3599/6358045 http://www.ncbi.nlm.nih.gov/pubmed/34447992?tool=bestpractice.com