Definition
- Acute heart failure (AHF): rapid onset or worsening of symptoms and signs of heart failure (HF), severe enough to need urgent assessment and treatment, usually in hospital (European Society of Cardiology, ESC 2021).
- Acute decompensated chronic heart failure (ADHF) is the most common form (about 50–70% of admissions). De novo AHF is the first presentation in a patient without known heart failure (often acute myocardial infarction, myocarditis or a sudden valve lesion).
- AHF is one of the leading causes of hospital admission in people over 65 years.
- Cardiac asthma (interstitial pulmonary oedema) and acute alveolar pulmonary oedema are two degrees of lung congestion in acute left heart failure; cardiogenic shock is failure of tissue perfusion caused by the heart.
Etiology and precipitating factors
The cause must be found in every patient, because it decides the specific treatment. The ESC groups the acute causes to exclude in the first hour or two under the mnemonic CHAMPIT:
Triggers of decompensation in chronic heart failure
- Non-adherence to salt and fluid restriction or to medication (the most frequent avoidable trigger), or withdrawal of diuretics.
- Infection (pneumonia, influenza, urinary tract), exacerbation of chronic obstructive pulmonary disease (COPD), anaemia, worsening renal function.
- Drugs that retain salt or depress the heart: non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, non-dihydropyridine calcium channel blockers (verapamil, diltiazem), thiazolidinediones, class I antiarrhythmics, cardiotoxic chemotherapy.
- Uncontrolled hypertension, myocardial ischaemia, new arrhythmia; alcohol and recreational drugs (cocaine, amphetamines).
- Metabolic and hormonal: thyrotoxicosis or hypothyroidism, diabetic ketoacidosis, adrenal insufficiency, pregnancy and the peripartum period.
- Others: surgery, stroke, excessive intravenous fluids, emotional or physical stress (takotsubo syndrome), high-output states (severe anaemia, sepsis, arteriovenous fistula).