Acute Systolic Heart Failure

Introduction

Acute systolic heart failure (ASHF) is a life-threatening condition where the heart's ability to pump blood effectively is severely impaired. This results in inadequate oxygen delivery to tissues and can lead to organ dysfunction or failure if not managed promptly.

Causes and Risk Factors

ASHF commonly arises due to: - Coronary artery disease (CAD) – A heart attack can weaken heart muscle function. - Hypertension – Chronic high blood pressure increases heart workload. - Arrhythmias – Irregular heart rhythms can impair effective pumping. - Myocarditis – Inflammation of heart muscle due to infections or immune conditions. - Heart valve disease – Dysfunctional valves increase strain on the heart. - Non-adherence to medication – Missing heart failure medications can trigger acute decompensation.

Symptoms of Acute Systolic Heart Failure

• Severe shortness of breath (especially when lying down)
• Rapid heart rate
• Fatigue and weakness
• Cough producing frothy, pink-tinged sputum (indicative of pulmonary edema)
• Swelling in the legs and abdomen
• Confusion or dizziness due to inadequate oxygen supply to the brain

Diagnosis

Healthcare providers use multiple methods to diagnose ASHF: - Clinical evaluation – Physical examination and symptom assessment. - Electrocardiogram (ECG) – Identifies arrhythmias or ischemic changes. - Echocardiogram – Evaluates ejection fraction (EF) and structural heart issues. - Blood tests – Including brain natriuretic peptide (BNP) levels to assess heart strain. - Chest X-ray – Detects pulmonary congestion and cardiomegaly.

Treatment Principles

Immediate Management

• Oxygen therapy – To relieve hypoxia.
• Diuretics (e.g., furosemide) – To reduce fluid overload.
• Vasodilators (e.g., nitroglycerin) – To decrease heart workload.
• Positive inotropes (e.g., dobutamine, milrinone) – Used in severe cases to enhance cardiac output.

Long-Term Management

• Lifestyle modifications - Sodium restriction, fluid management, and regular exercise.
• Medications:
  • ACE inhibitors/ARBs for afterload reduction.
  • Beta-blockers to improve heart function and survival.
  • Mineralocorticoid receptor antagonists (e.g., spironolactone) for additional cardioprotection.
• Cardiac devices – Implantable cardioverter defibrillators (ICDs) or cardiac resynchronization therapy (CRT) for some patients.
• Heart transplant or LVAD – For end-stage heart failure.

Prevention

• Effective management of underlying conditions (e.g., hypertension, diabetes, coronary artery disease).
• Medication adherence.
• Regular follow-ups with a cardiologist.

Conclusion

Acute systolic heart failure is a serious medical emergency requiring rapid recognition and intervention. With appropriate acute management and long-term treatment strategies, outcomes for patients can be improved.

Source recommendations

1. American Heart Association Guidelines for the Management of Heart Failure

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://professional.heart.org/en/guidelines-and-statements
3. https://www.heart.org/en/health-topics/heart-failure
4. https://professional.heart.org/en/science-news/-/media/832EA0F4E73948848612F228F7FA2D35.ashx
5. https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure

2. European Society of Cardiology 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://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines
4. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
5. https://pubmed.ncbi.nlm.nih.gov/27206819/