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168 Cardio Diabetes Medicine 2017

Clinical Presentation and

Management of Acute Heart Failure

Dr. Prayaag Kini

Consultant, Dept of Cardiology, Sri Sathya Sai Institute of Higher Medical
Sciences Whitefield , Bangalore ,India

ABSTRACT patient with AHF at each stage of in-hospital man-
Acute decompensated heart failure (ADHF) is a com- agement is fundamental to adjust therapy to actual
mon and potentially fatal clinical syndrome charac- clinical conditions.
terized by the development of dyspnea, generally
associated with rapid accumulation of fluid within Clinical Diagnosis of Acute Heart Failure
the lung’s interstitial and alveolar spaces, most com- Acute heart failure (AHF) is essentially a pump failure
monly due to left ventricular systolic or diastolic dys- causing downstream hypoperfusion and upstream
function, with or without additional cardiac patholo- congestion. The initial diagnosis of AHF is based on
gy, such as coronary artery disease or valve abnor- the presence of clinical symptoms and signs and is
malities Clinical profiling is essential for determining further confirmed by appropriate additional investi-
the underlying cause and pathophysiology involved gations such as ECG, chest X-ray, laboratory assess-
in an individual patient for tailoring therapy. The mul- ment (with specific biomarkers), and echocardiogra-
titude of newer therapies on the horizon for AHF only phy. Typically, the clinical picture results from symp-
serves to remind us that the ideal “magic bullet” for toms and signs resulting from overt or covert fluid
AHF treatment is still elusive, keeping the manage- retention (pulmonary congestion and/or peripheral
ment of AHF, in real clinical sense, a ”moving target”. edema) and is less often related to reduced cardiac
output with peripheral hypoperfusion.
Introduction Symptoms of AHF are manifestation of conges-
Despite major achievements in the treatment of tion, reflecting elevated ventricular filling pressures;
chronic heart failure (HF) over the last decades, left-sided HF may be characterized by orthopnea,
which led to marked improvement in long-term sur- paroxysmal nocturnal dyspnea, and breathlessness
vival, outcomes of AHF remain poor with 90-day at rest or with minimal exertion, whereas right-sided
re-hospitalisation and 1-year mortality rates reach- HF can be characterized by peripheral edema, as-
ing 10–30%. Despite lacking evidence of beneficial cites, and symptoms of gut congestion. Systematic
effects on outcome, acute treatment of AHF still physical examination is essential in the diagnostic
mainly consists of non-invasive ventilation in case process of AHF and should always contain an eval-
of pulmonary oedema, intravenous diuretics and/or uation of the following:
vasodilators, generally tailored according to the initial
haemodynamic status without specific regard to the -Peripheral perfusion, for which low systolic blood
underlying pathophysiological irregularities. pressure and cold skin temperature are the most ac-
cessible measures of hypoperfusion; additionally, the
During the last two decades a more complex net- patient may show confusion, dizziness, and anuria/
work of interactions has been added to the simplis- oliguria.
tic haemodynamic model for explaining the patho-
physiology and dynamic nature of AHF. It is not an -The presence of signs associated with elevated
understatement to say that multiple clinical presen- filling-pressures (left-sided: bi-basal rales, an audi-
tations are a typical feature of acute heart failure. ble third heart sound, an abnormal blood pressure
Thus, careful and comprehensive evaluation of each response to the Valsalva maneuver, or right-sided:

GCDC 2017