Cardiac Failure Acute
Acute heart failure is a sudden, life-threatening medical emergency where your heart cannot pump enough blood to meet your body’s needs, causing oxygen-rich blood to fail reaching vital organs and tissues.
Table of contents
- What is acute heart failure?
- Types of acute heart failure
- Warning signs and symptoms
- What causes acute heart failure?
- Risk factors and triggers
- Possible complications
- How is it diagnosed?
- Treatment approaches
- Living with heart failure
What is acute heart failure?
Acute heart failure describes a condition where your heart suddenly cannot deliver enough oxygen-rich blood to your body[1]. This happens because of a sudden, rapid decline in how well your heart works and the amount of blood it can pump to the rest of your body[1]. Your heart is still beating, but it cannot handle the amount of blood it should, causing blood to build up in other parts of your body[17].
When your heart cannot keep up with its pumping duties, blood often backs up and fluid can build up in your lungs and legs over time[2]. Most of the time, fluid collects in your lungs, legs, and feet[17]. This buildup of fluid causes many of the symptoms people experience during acute heart failure.
Heart disease and certain medical conditions can make your heart work harder than usual. This extra effort leads to physical changes over time, including an enlarged heart, decreased blood flow, narrow blood vessels, rapid or irregular heartbeat, and stiff heart muscles[1]. The changes are small at first and start long before you experience symptoms. Over time, the changes get worse, making your heart work harder than it should. When your heart is no longer able to keep up, acute heart failure occurs[1].
Acute heart failure is one of the most common reasons for a hospital stay for people older than 65[1]. In the United States, nearly 6.7 million adults 20 years old or older have heart failure[8].
Types of acute heart failure
Acute heart failure can happen even if you do not have a previous heart problem[1]. There are different types:
Acute decompensated heart failure (ADHF) occurs when you already have a heart condition like coronary artery disease[1]. This is when chronic heart failure suddenly becomes much worse[7]. A heart experiencing heart failure can typically compensate to a certain degree, but over time, the heart can become stiffer and may stop being able to compensate for its inefficiency[7].
De novo acute heart failure means you can get this type if you have no history of heart disease[1]. You may have an ongoing health condition like diabetes that damages your heart[1]. Sometimes this type can result directly from the onset of a new cardiac problem, most frequently an acute coronary syndrome (a term for conditions where blood flow to the heart is suddenly blocked)[6].
Heart failure can also affect different sides of your heart. Left-sided heart failure occurs when the left ventricle, which is the main pumping chamber of the heart, is unable to pump enough blood to the body. This can lead to fluid buildup in the lungs and difficulty breathing[7]. Right-sided heart failure occurs when the right ventricle, which pumps blood to the lungs, cannot pump enough blood to the left side of the heart. This can lead to a buildup of fluid in the body and swelling in the legs and abdomen[7]. Left-sided heart failure is the most common cause of right-sided heart failure[17].
Warning signs and symptoms
One of the most common acute heart failure symptoms is shortness of breath, also called dyspnea[1]. You may experience heavy breathing, a sensation like suffocating, struggling to breathe while lying down, or a tight chest[1]. The symptoms of acute and chronic heart failure are fairly similar, but the main difference is that the onset of symptoms in acute heart failure tends to be quicker and slightly more severe[7].
Other symptoms of acute heart failure may include:
- Abnormal heart rhythm, known as arrhythmia[1]
- Chest pain[1]
- Cough[1]
- Fluid retention, called edema, in your arms or legs[1]
- Loss of consciousness[1]
- Heart palpitations (feeling your heart beating)[9]
- Fatigue when you are active[9]
- Swelling in your ankles, legs, and abdomen[9]
- Weight gain[9]
- Need to urinate while resting at night[9]
- A dry, hacking cough[9]
- A full or hard stomach[9]
- Loss of appetite or upset stomach[9]
If you notice any of these symptoms, seek emergency medical care as quickly as possible[1]. The sooner you receive treatment, the better your chances of recovery[1]. You should call emergency services (such as 911 in the United States) if you have severe shortness of breath, an irregular or fast heartbeat, or if you cough up foamy, pink mucus[21].
Sometimes, you may have mild symptoms of heart failure or none at all. This does not mean you do not have heart failure anymore[9]. Symptoms of heart failure can range from mild to severe and may come and go[9]. Unfortunately, heart failure usually gets worse over time[9].
What causes acute heart failure?
A diagnosis of acute heart failure is made when patients present with signs and symptoms of heart failure, often with worsening of pre-existing heart muscle disease[3]. In the presence of an underlying structural or functional cardiac problem (whether chronic or undiagnosed), one or more triggering factors can cause acute heart failure[6].
Causes of acute heart failure include health issues that strain your heart, such as:
- Heart rhythm problems (arrhythmia)[1]
- Coronary artery disease[1]
- Heart valve disease[1]
- Cardiomyopathy (a disease of the heart muscle)[1]
- Advanced kidney disease[1]
- Alcohol use disorder[1]
- Blood clot in your lung, called pulmonary embolism[1]
- Diabetes[1]
- High blood pressure, also known as hypertension[1]
- Overactive thyroid, called hyperthyroidism[1]
- Sleep apnea[1]
- Stroke[1]
- Viral infections that affect your heart[1]
Heart attacks from heart disease are a common cause. Coronary artery disease describes a condition where plaque builds up in the arteries[7]. Over time, this plaque buildup can stiffen arteries and increase the likelihood of experiencing a heart attack[7]. A heart attack occurs when a clot in the coronary artery cuts off the blood supply to the heart muscle[7]. If the blockage goes on for too long, it can cause heart tissue to die, which can drastically reduce the heart’s efficiency in pumping blood[7].
A buildup of fluid in the body can also cause acute heart failure. Fluid buildup can be caused by a malfunction of organs like the kidneys[7]. If this imbalance becomes significant enough, it can cause a condition known as fluid overload. In this scenario, there is too much fluid within the body and blood. More blood volume means that the heart must work harder, which places it under stress. This can quickly lead to acute heart failure if not addressed[7].
Risk factors and triggers
Risk factors for heart failure include:
- Being older than 65[17]
- Using tobacco products, cocaine, or alcohol[17]
- Having an inactive lifestyle[17]
- Eating foods that have a lot of salt and fat[17]
- Having high blood pressure[17]
- Having coronary artery disease[17]
- Having a heart attack[17]
- Having a family history of heart failure[17]
While you may have a condition that can cause acute heart failure, certain behaviors may trigger it[1]. These include:
- Not taking prescribed medicines[1]
- Not limiting salt or fluids[1]
- Using alcohol, substances, or recreational drugs[1]
- Taking NSAIDs (nonsteroidal anti-inflammatory drugs)[1]
Possible complications
Acute heart failure can lead to serious, life-threatening complications. One major complication is organ dysfunction, which occurs when your organs do not get enough blood and oxygen[1]. Cardiogenic shock is another complication of acute heart failure[1]. Both of these conditions are life-threatening[1].
Other complications from heart failure include:
- Irregular heartbeat[17]
- Sudden cardiac arrest[17]
- Heart valve problems[17]
- A collection of fluid in your lungs[17]
- Pulmonary hypertension (high blood pressure in the lungs)[17]
- Kidney damage[17]
- Liver damage[17]
- Malnutrition[17]
How is it diagnosed?
Healthcare providers perform a rapid assessment when acute heart failure is suspected[1]. This includes reviewing your health history, including your personal or family history of heart disease and other health conditions you have[1].
For any patient with suspected heart failure, doctors will always record and interpret a 12-lead electrocardiogram (ECG), a test that records the electrical signals in your heart, and monitor this continuously[4]. Doctors will also always order a chest x-ray and blood tests, including N-terminal-proB-type natriuretic peptide (NT-proBNP) or BNP (proteins released when the heart is under stress), as well as other standard blood tests[4].
An echocardiogram uses sound waves to create images of the beating heart and is performed to establish the presence or absence of heart abnormalities[4]. This test shows the size and structure of the heart and heart valves and blood flow through the heart[11]. One important measurement taken during an echocardiogram is the ejection fraction, which is the percentage of blood leaving your heart each time it squeezes[11]. The result helps classify heart failure and guides treatment[11].
Doctors arrange immediate bedside echocardiography and ECG for any patient who is unstable (with low blood pressure or shock) or in respiratory failure with suspected acute heart failure as part of looking for life-threatening causes[4].
Treatment approaches
Acute heart failure requires emergency medical care[1]. People with acute heart failure often spend several days in the hospital and receive oxygen and medicines[1]. Doctors urgently identify and treat any underlying causes of acute heart failure that must be managed immediately to prevent further rapid deterioration[4].
Doctors determine treatment based on the patient’s clinical presentation, including blood pressure status and the presence of shock[4]. Drug treatment options include medicines that affect blood vessels (vasoactive drugs), diuretics (water pills that help remove excess fluid), and vasodilators (medicines that open blood vessels)[4].
Diuretics make you pass more urine and help relieve ankle swelling and breathlessness caused by heart failure[13]. After stabilization, doctors start an oral diuretic if the patient has symptoms or signs of fluid buildup, or switch from an intravenous to an oral diuretic once a patient who was started on an intravenous diuretic in the acute phase has normal fluid levels[4].
After the emergency phase, treatment is planned based on measurement of the patient’s left ventricular ejection fraction using echocardiography and their level of symptoms[4]. Most people with heart failure are treated with medication, often needing to take 2 or 3 different medicines[13]. Treatment usually includes:
- Taking medicines[8]
- Reducing sodium in the diet[8]
- Drinking less liquids[8]
- Getting daily physical activity[8]
Common types of medicines for heart failure include ACE inhibitors (drugs ending in “pril”), angiotensin receptor blockers (ARBs), beta-blockers (drugs ending in “olol”), mineralocorticoid receptor antagonists, and SGLT2 inhibitors (a type of diabetes medicine that also helps heart failure)[13]. Treatment with an SGLT2 inhibitor is recommended for most stabilized patients with heart failure regardless of their ejection fraction or whether they have diabetes[4].
It is important for patients to have input from the heart failure specialist team within 24 hours of admission to hospital[4]. Treatment usually needs to continue for the rest of your life[13], although in some cases where heart failure has a treatable cause, a cure may be possible[5].
Living with heart failure
If you have heart failure, it is important to look after your own health and well-being[16]. There are many things you can do to feel better, avoid the hospital, and live longer[21]. Self-care means managing your health by doing certain things every day[21].
Top self-care tips include:
- Take your medicines as prescribed. This gives them the best chance of helping you[21]
- Weigh yourself every day. Weight gain may be a sign that your body is holding on to too much fluid. Weigh yourself at the same time each day, using the same scale. The best time is in the morning after you go to the toilet and before you eat or drink anything[21]
- Keep a daily record of your symptoms. Checking your symptoms helps you see what symptoms are normal for you and if they change or get worse[21]
- Limit sodium. This helps keep fluid from building up and may help you feel better[21]
- Try to exercise regularly after talking with your doctor[21]
You should call your doctor or nurse advice line if you have sudden weight gain, new or worse swelling in your feet, ankles, or legs, your breathing gets worse, or your breathing when you lie down is worse than usual[21].
Other important steps to stay healthy include:
- Eat heart-healthy foods including vegetables, fruits, nuts, beans, lean meat, fish, and whole grains[21]
- Stay at a healthy weight[21]
- If you smoke, quit[21]
- Limit or avoid alcohol[21]
- Manage other health problems such as diabetes and high blood pressure[21]
- Avoid infections such as COVID-19, colds, and flu by getting vaccinated[21]
You will have regular contact with your doctor or care team to monitor your condition at least every 6 months[16]. These appointments may involve talking about your symptoms, discussing your medication, and tests to monitor your health[16]. It is also a good opportunity to ask any questions you have[16].
Heart failure is a serious long-term condition that will usually continue to get slowly worse over time[5]. However, it is very difficult to tell how the condition will progress on an individual basis, as it is very unpredictable[5]. Many people remain stable for many years[5].
cardiac failure acute, congestive heart failure, acute decompensated heart failure, de novo acute heart failure, ADHF
- Heart
- Left ventricle
- Right ventricle
- Blood vessels
- Lungs
