Acute heart failure
- Incidence: 200.00 cases per 100,000 person-years
- Peak incidence: 70+ years
- Sex ratio: 1:1
|Acute exacerbation of COPD||3.75|
|Acute heart failure||1|
De-novo heart failure is caused by and increased cardiac filling pressures and myocardial dysfunction usually as a result of ischaemia. This causes reduced cardiac output and therefore hypoperfusion. This, in turn can cause pulmonary oedema. Other less common causes of de-novo AHF are:
- Viral myopathy
- Valve dysfunction
Decompensated heart failure accounts for most cases of AHF. The most common precipitating causes of acute AHF are:
- Acute coronary syndrome
- Hypertensive crisis: e.g. bilateral renal artery stenosis
- Acute arrhythmia
- Valvular disease
There is generally a history of pre-existing cardiomyopathy. It usually presents with signs of fluid congestion, weight gain, orthopnoea and breathlessness.
|Reduced exercise tolerance||Tachycardia|
|Oedema||Elevated jugular venous pressure|
|Faitgue||Displaced apex beat|
|Chest signs: classically bibasal crackles but may also cause a wheeze|
Sometimes the presentation will be that of the underlying cause (e.g: chest pain, viral infection)
Over 90% of patients with AHF have a normal or increased blood pressure (mmHg).
- Blood tests – this is to look for any underlying abnormality such as anaemia, abnormal electrolytes or infection.
- Chest X-ray – findings include pulmonary venous congestion, interstitial oedema and cardiomegaly
- Echocardiogram – this will identify pericardial effusion and cardiac tamponade
- B-type natriuretic peptide – raised levels (>100mg/litre) indicate myocardial damage and are supportive of the diagnosis.
- inotropic agents
- mechanical circulatory assistance: e.g. intra-aortic balloon counterpulsation or ventricular assist devices
Consideration should be given to discontinuing beta-blockers in the short-term.