What Tests Will I Need
Healthcare providers use a variety of tests to assess your symptoms, such as:
- Electrocardiogram to record and assess the hearts electrical activity.
- Chest X-ray to check for fluid build-up in the heart or lungs.
- Echocardiogram to show heart movement and blood flow.
- Angiography or heart catheterization to examine the hearts blood vessels.
You may also need lab tests that include:
- BNP blood test to check for hormones that occur when pressures change inside the heart.
- Basic metabolic panel which shows signs of kidney or thyroid issues.
How Will My Life Be Different After Acute Heart Failure
Life after acute heart failure often includes changes, like getting more physical activity. You may also need to avoid certain foods and limit salt and fat intake.
It’s important to pay careful attention to your body. This can help you detect the early signs of heart failure that come back after treatment. Your daily routine may include weighing yourself to check for fluid retention. Ongoing medical care can help you feel your best.
A note from Cleveland Clinic
Acute heart failure is a sudden, life-threatening condition that occurs when your heart can no longer do its job. ADHF occurs in people with a history of heart disease. De novo heart failure is due to other medical conditions affecting the heart. You should seek emergency medical treatment if you experience heart failure symptoms. Timely care can save your life. And ongoing therapies lower the risk of future heart issues.
Stages Of Heart Failure
CHF is usually an irreversible condition that gets worse over time. The stages of heart failure describe the severity of the conditions. Here are the four stages of heart failure according to the American College of Cardiology:
- Stage A: People have a high risk for developing heart failure, but there are no symptoms or changes in heart function. People in this category often have one or more conditions that may lead to heart failure.
- Stage B: People with stage B heart failure have changes to the heart function but havent experienced symptoms of heart failure. The ejection fraction may be below normal range.
- Stage C: During this stage, people will experience decreased heart function and currently or previously experienced symptoms of heart failure.
- Stage D: In stage D, people experience constant symptoms of heart failure. If they have heart failure with reduced ejection fraction. the ejection fraction will be significantly lower.
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Centre For Academic Primary Care
Acute exacerbation of heart failure
|Exacerbation of congestive heart failure
|Exacerbation of heart failure in a person with known reduced ejection fraction:
How Do You Treat Chf Exacerbation
Patients who have CHF exacerbation are usually admitted to the hospital for treatment. Depending on medical history, treatment may include diuretics to treat edema, beta-blockers to slow down the heart rate, and ACE inhibitors to lower blood pressure. When discharged from the hospital, you may receive a new treatment plan to help prevent future exacerbations.
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What Causes Heart Failure
Although the risk of heart failure doesnt change as you get older, youre more likely to have heart failure when youre older.
Many medical conditions that damage the heart muscle can cause heart failure. Common conditions include:
- Tobacco and recreational drug use.
- Medications. Some drugs used to fight cancer can lead to heart failure.
Will I Need Other Treatments
After you leave the hospital, you may need medications, like beta blockers or water pills, to maximize heart health. Other treatments may be necessary to prevent future episodes of acute heart failure.
These treatments may include surgery to:
- Stent placement or coronary bypass surgery for coronary artery disease.
- Repair or replace worn-out heart valves .
- Implant a pacemaker or implantable cardioverter defibrillator to help you maintain a regular heartbeat and help treat dangerous heart rhythms.
- Replace your heart with a healthy one from a donor .
- Give your heart extra help with a ventricular assist device until you can have a transplant.
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Pathophysiological Mechanisms Of Ahf
An underlying structural or functional cardiac condition is a prerequisite for AHF and includes a multitude of different acute or chronic cardiac pathologies. The underlying cardiac disease leads to the activation of several pathophysiological pathways that counter the negative effects of HF on oxygen delivery to the peripheral tissues, but such pathways can also eventually cause systemic congestion, ventricular remodelling and organ dysfunction. Furthermore, some acute diseases can act as precipitating factors and trigger AHF either by directly impairing cardiac diastolic and/or systolic function or by further promoting systemic congestion. Systemic congestion has a major effect on the clinical presentation in the majority of patients with AHF and is a relevant determinant of multi-organ dysfunction occurring in AHF . The pathophysiology of AHF is heterogeneous, as it is greatly affected by the nature of the underlying cardiac disease. It is perhaps not surprising, therefore, that the responses to treatment may vary and that different patients may respond best to distinct treatment strategies that depend on the underlying pathophysiology.
Fig. 1: Schematic representation of possible pathophysiological mechanisms in AHF.
LV systolic and diastolic dysfunction
What Are The Complications Of Heart Failure
Some of the complications from heart failure include:
- Irregular heartbeat.
- History of taking drugs that can damage your heart muscle, such as some cancer drugs.
Stage B is considered pre-heart failure. It means your healthcare provider has given you a diagnosis of systolic left ventricular dysfunction but youve never had symptoms of heart failure. Most people with Stage B heart failure have an echocardiogram that shows an ejection fraction of 40% or less. This category includes people who have heart failure and reduced EF due to any cause.
People with Stage C heart failure have a heart failure diagnosis and currently have or previously had signs and symptoms of the condition.
There are many possible symptoms of heart failure. The most common are:
- Shortness of breath.
- Need to urinate while resting at night.
- Rapid or irregular heartbeats .
- A dry, hacking cough.
- A full or hard stomach, loss of appetite or upset stomach .
There may be times that your symptoms are mild or you may not have any symptoms at all. This doesn’t mean you no longer have heart failure. Symptoms of heart failure can range from mild to severe and may come and go.
Unfortunately, heart failure usually gets worse over time. As it worsens, you may have more or different signs or symptoms.Its important to let your doctor know if you have new symptoms or if your symptoms get worse.
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What Is Congestive Heart Failure
The term heart failure might sound like the heart has stopped working entirely but this is actually not the case. Rather, this is a common problem that affects around 6 million Americans with 670,000 new cases diagnosed each year.
What CHF actually describes is a weakening of the heart. This means that the power it has to pump blood around the body has been reduced and therefore the blood and oxygen move around the body at a slower rate. This can result in the chambers of the heart enlarging in order to hold more blood to pump or it might cause them to become stiffer and thickened to keep the blood moving. The danger is that the muscle walls in the heart might eventually grow even weaker and therefore be unable to maintain circulation. At this point, the kidneys can respond by causing the body to retain fluid and salt which might build up in the arms, legs, ankles and feet. The body thus becomes congested and hence the term congestive heart failure is used to describe this condition.
New Us Guidance Includes Updated Recommendations On Classification Of Heart Failure Prevention And Treatment Of Symptomatic Disease
A joint guideline has been released by the American Heart Association, American College of Cardiology, and Heart Failure Society of America. Revised recommendations, based on contemporary evidence and acknowledging the increasingly diverse heart failure patient populations seen in practice, include:
A heart failure classification that includes heart failure with mildly reduced ejection fraction and heart failure with improved ejection fraction , alongside existing categories
Indications for temporary and durable mechanical circulatory support in patients with advanced heart failure
Post-stabilization therapy for patients with heart failure with reduced ejection fraction now includes drugs from four medication classes, including sodium-glucose cotransporter 2 inhibitors regardless of whether they have type 2 diabetes mellitus.
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What Are The Types Of Heart Failure
There are many causes of heart failure, but the condition is generally broken down into these types:
Left-sided heart failure
Heart failure with reduced left ventricular function The lower left chamber of your heart gets bigger and cannot squeeze hard enough to pump the right amount of oxygen-rich blood to the rest of your body.
Heart failure with preserved left ventricular function Your heart contracts and pumps normally, but the bottom chambers of your heart are thicker and stiffer than normal. Because of this, your ventricles can’t relax properly and fill up all the way. Because there’s less blood in your ventricles, your heart pumps out less blood to the rest of your body when it contracts.
Right-sided heart failure
Heart failure can also affect the right side of your heart. Left-sided heart failure is the most common cause of this. Other causes include certain lung problems and issues in other organs.
How Is Acute Heart Failure Diagnosed
Healthcare providers perform a rapid assessment that includes:
- Your health history, including your personal or family history of heart disease. Theyll want to know about other health conditions like whether you use tobacco products and any medications you take.
- A physical exam to learn more about your symptoms and how severe they are. This includes listening to your heart and checking for signs of edema.
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What Is Heart Failure
Heart failure, or congestive heart failure, is a long-term condition that gets worse over time. Although the name sounds like your heart has stopped working, heart failure means your heart isnt able to pump blood as well as it should. When your heart has less pumping power, that can damage your organs and fluid can collect in your lungs.
Types Of Heart Failure
The two types of heart failure include:
- Heart failure with reduced ejection fraction , previously known as systolic heart failure, develops when the ejection fraction is 40% or less. A 2020 research review stated about 50% of heart failure cases have a reduced ejection fraction. Additional risk factors for HFrEF include male sex, age, cardiomyopathy, and other heart diseases.
- Heart failure with preserved ejection fraction , previously known as diastolic heart failure, is heart failure in people who don’t have a significant change in ejection fraction. Additional risk factors for HFpEF include atrial fibrillation, pulmonary hypertension, high body mass index , and smoking.
Another type of heart failure called right-sided heart failure can develop. However, it’s a more uncommon condition with different causes and symptoms.
Myocytes And Myocardial Remodeling
In the failing heart, increased myocardial volume is characterized by larger myocytes approaching the end of their life cycle. As more myocytes drop out, an increased load is placed on the remaining myocardium, and this unfavorable environment is transmitted to the progenitor cells responsible for replacing lost myocytes.
Progenitor cells become progressively less effective as the underlying pathologic process worsens and myocardial failure accelerates. These featuresnamely, the increased myocardial volume and mass, along with a net loss of myocytesare the hallmark of myocardial remodeling. This remodeling process leads to early adaptive mechanisms, such as augmentation of stroke volume and decreased wall stress and, later, to maladaptive mechanisms such as increased myocardial oxygen demand, myocardial ischemia, impaired contractility, and arrhythmogenesis.
As heart failure advances, there is a relative decline in the counterregulatory effects of endogenous vasodilators, including nitric oxide , prostaglandins , bradykinin , atrial natriuretic peptide , and B-type natriuretic peptide . This decline occurs simultaneously with the increase in vasoconstrictor substances from the RAAS and the adrenergic system, which fosters further increases in vasoconstriction and thus preload and afterload. This results in cellular proliferation, adverse myocardial remodeling, and antinatriuresis, with total body fluid excess and worsening of heart failure symptoms.
What Is The Importance Of Ejection Fraction
Your ejection fraction is one way to measure the severity of your condition. If its below normal, it can mean that you have heart failure. Your ejection fraction tells your healthcare provider how good of a job your left or right ventricle is doing at pumping blood. Usually, your EF number is talking about how much blood your left ventricle is pumping out because its your heart’s main pumping chamber.
Several non-invasive tests can measure your EF. With this information, your healthcare provider can decide how to treat you or find out if a treatment is working as it should.
A normal left ventricular ejection fraction is 53% to 70%. An LVEF of 65%, for example, means that 65% of the total amount of blood in your left ventricle is pumped out with each heartbeat. Your EF can go up and down, based on your heart condition and how well your treatment works.
How Is Chf Diagnosed
After reporting your symptoms to your doctor, they may refer you to a heart specialist, or cardiologist.
The cardiologist will perform a physical exam, which will involve listening to your heart with a stethoscope to detect abnormal heart rhythms.
To confirm an initial diagnosis, a cardiologist might order certain diagnostic tests to examine your hearts valves, blood vessels, and chambers.
There are a variety of tests used to diagnose heart conditions. Because these tests measure different things, your doctor may recommend a few to get a full picture of your current condition.
Congestion And Organ Dysfunction
In the heart, elevated ventricular filling pressures lead to increased ventricular wall tension, myocardial stretch and remodelling, contributing to a progressive worsening in cardiac contractility, valvular regurgitation and systemic congestion. In response to the increased wall tension, circulating natriuretic peptides are physiologically released by atrial and ventricular cardiomyocytes as a compensatory mechanism, and often high-sensitivity cardiac troponins are detectable in a large proportion of patients with AHF, revealing nonischaemic myocyte injury or necrosis. Increases in left atrial pressure and mitral valve regurgitation will increase the hydrostatic pressure in the pulmonary capillaries, thereby increasing fluid filtration rate from the capillaries to the pulmonary interstitium, causing lung stiffness and dyspnoea. Notably, the relationship between hydrostatic pressure and interstitial fluid content is rather complex, as other mechanisms are involved in fluid homeostasis. For example, the lymphangiogenic factor VEGF-D has been found to regulate and mitigate pulmonary and systemic congestion in patients with HF or renal failure,,. Indeed, in the early stage of lung congestion, the lymphatic system can cope with the large volume of interstitial fluid, but eventually, the drainage capacity is exceeded. Hence, fluid moves to pleural and intra-alveolar spaces causing pleural effusion and pulmonary oedema.
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Systolic And Diastolic Failure
Systolic and diastolic heart failure each result in a decrease in stroke volume. This leads to activation of peripheral and central baroreflexes and chemoreflexes that are capable of eliciting marked increases in sympathetic nerve traffic.
Although there are commonalities in the neurohormonal responses to decreased stroke volume, the neurohormone-mediated events that follow have been most clearly elucidated for individuals with systolic heart failure. The ensuing elevation in plasma norepinephrine directly correlates with the degree of cardiac dysfunction and has significant prognostic implications. Norepinephrine, while directly toxic to cardiac myocytes, is also responsible for a variety of signal-transduction abnormalities, such as downregulation of beta1-adrenergic receptors, uncoupling of beta2-adrenergic receptors, and increased activity of inhibitory G-protein. Changes in beta1-adrenergic receptors result in overexpression and promote myocardial hypertrophy.
What Is An Exacerbation Of Congestive Heart Failure
An exacerbation of CHF is a sudden and prolonged worsening of a patients CHF symptoms, such as an in-creased shortness of breath, mental confusion, leg swelling, fatigue, and weight gain. In severe cases, an exacerbation of CHF can be complicated by extreme shortness of breath. The patient even may report a feeling of drowning. The patient may cough up pink frothy sputum or may even become confused or unconscious.
A CHF exacerbation is a medical emergency and re-quires the immediate attention of a doctor. Exacerbations of CHF occur when there is an in-creased demand placed on the heart that the weakened heart cannot compensate for by beating harder or faster. These increased demands may be the result of cardiac or noncardiac changes. These exacerbations often are life threatening and can lead to hospitalization. The number of CHF exacerbations per year and the severity of exacerbations can increase as the disease progresses and the heart becomes less able to handle increased loads. Heart failure exacerbations are very common reasons for hospitalization in the United States and Canada. In severe cases, the patient needs the mechanical support of a ventilator until the acute symptoms have resolved.
Some other causes of CHF exacerbation are:
- Excessive alcohol intake
- Irregular heartbeats
- Coronary artery disease
- Side effects of medications
- Increased high blood pressure
- Heart valve infections
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