Acute Heart Failure

Introduction

Acute heart failure (AHF) is a life-threatening condition in which the heart suddenly loses its ability to pump blood effectively. It can develop as a worsening of chronic heart failure or appear suddenly in a previously healthy person. Prompt diagnosis and treatment are essential to improve outcomes and prevent complications.

Causes of Acute Heart Failure

AHF can result from various underlying conditions, including:

• Myocardial infarction (heart attack) – Damage to heart muscle reduces its pumping ability.
• Arrhythmias – Abnormal heart rhythms can impair cardiac output.
• Hypertensive crisis – Severe, sudden rise in blood pressure increases heart workload.
• Pulmonary embolism – A blood clot in the lungs can obstruct circulation and stress the heart.
• Infections (e.g., sepsis, myocarditis) – Infections can cause inflammation and weaken the heart.
• Valvular heart disease – Sudden worsening of valve disorders leads to ineffective circulation.
• Non-compliance with heart failure medications – Missing medications can rapidly worsen heart function.

Symptoms of Acute Heart Failure

Patients with AHF may experience:

• Severe shortness of breath (often with fluid in the lungs).
• Swelling (edema) in the legs and abdomen.
• Chest pain or discomfort.
• Extreme fatigue and weakness.
• Confusion or dizziness due to low oxygen supply.
• Sudden weight gain due to fluid retention.

Diagnosis

To diagnose AHF, doctors use:

• Physical examination (checking heart sounds, lung congestion, and edema).
• Electrocardiogram (ECG) to detect heart rhythm abnormalities.
• Echocardiography (heart ultrasound) to assess heart structure and function.
• Blood tests (e.g., BNP/NT-proBNP levels) to evaluate heart strain.
• Chest X-ray to detect fluid accumulation in the lungs.

Treatment Approaches

Immediate Management

• Oxygen therapy: To improve oxygenation in the blood.
• Diuretics (e.g., furosemide): To relieve fluid overload and reduce lung congestion.
• Vasodilators (e.g., nitroglycerin): To decrease heart workload and improve circulation.
• Inotropic drugs (e.g., dobutamine): To enhance cardiac contractility in severe cases.

Long-Term Management

• Addressing underlying causes (e.g., treating infections, managing hypertension).
• Medications (beta-blockers, ACE inhibitors, aldosterone antagonists).
• Lifestyle modifications: Salt restriction, fluid control, weight monitoring.
• Implantable devices (pacemakers, defibrillators) in selected patients.

Conclusion

Acute heart failure is a medical emergency that requires rapid intervention. Proper treatment can significantly improve survival and quality of life. Patients with a history of heart failure should closely monitor their symptoms and adhere to prescribed treatments.

Source recommendations

1. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

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

2. American College of Cardiology/American Heart Association 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/