Acute Congestive Heart Failure (ACHF)

Introduction

Acute Congestive Heart Failure (ACHF) is a critical condition in which the heart suddenly becomes unable to pump blood effectively. This leads to fluid buildup in the lungs and other parts of the body, causing severe breathing difficulties and other life-threatening symptoms.

Causes of ACHF

ACHF can be triggered by various factors, including: - Hypertension (high blood pressure) – Increased pressure weakens the heart over time. - Coronary artery disease (CAD) – Blockages in the heart arteries reduce blood supply to the heart. - Myocardial infarction (heart attack) – Damage to heart tissue can impair its ability to pump blood. - Arrhythmias (irregular heartbeats) – Abnormal rhythms can reduce the heart’s efficiency. - Cardiomyopathy – Diseases that weaken the heart muscle. - Infections or inflammation of the heart (e.g., myocarditis, endocarditis).

Symptoms and Diagnosis

Common symptoms of ACHF include: - Severe shortness of breath, especially when lying down - Swelling in the legs and abdomen due to fluid retention - Cough with frothy sputum, sometimes with a pink tinge - Fatigue and weakness - Rapid heartbeat and chest discomfort

Diagnosis is based on: - Clinical examination - Echocardiography (ultrasound of the heart) - Chest X-ray (to assess lung congestion) - BNP/NT-proBNP blood test (to detect heart failure severity)

Treatment Approaches

Management of ACHF involves rapid intervention to alleviate symptoms and stabilize the patient. Key treatments include:

1. Immediate Care

• Oxygen therapy – To ease breathing
• Diuretics (e.g., furosemide) – To remove excess fluid
• Vasodilators (e.g., nitroglycerin) – To reduce heart strain
• Inotropic agents (if needed) – To improve heart function

2. Long-Term Management

• Managing underlying conditions (e.g., hypertension, diabetes, arrhythmias)
• Lifestyle changes – Low-sodium diet, fluid restrictions, and regular physical activity
• Medications:
  • Beta-blockers and ACE inhibitors for heart protection
  • Aldosterone antagonists (e.g., spironolactone) to reduce fluid retention
  • SGLT2 inhibitors (new medications beneficial for heart failure)
• Device therapy (e.g., pacemakers, implantable defibrillators) in selected cases

Conclusion

Acute congestive heart failure requires urgent medical attention. Early diagnosis and appropriate treatment can significantly improve survival and quality of life. Patients should follow their doctor's advice, take medications as prescribed, and adopt a heart-healthy lifestyle.

Source recommendations

1. American College of Cardiology/American Heart Association (ACC/AHA) Heart Failure Guidelines

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://www.acc.org/Guidelines
3. https://www.jacc.org/doi/10.1016/j.jacc.2023.12.024
4. https://www.acc.org/education-and-meetings/products-and-resources/features/global-cv-institute/heart-failure-guidelines
5. https://pubmed.ncbi.nlm.nih.gov/35363499/

2. European Society of Cardiology (ESC) Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
2. https://pubmed.ncbi.nlm.nih.gov/34447992/
3. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
4. https://pubmed.ncbi.nlm.nih.gov/22611136/
5. https://academic.oup.com/eurheartj/article/44/37/3627/7246292