Acute heart failure

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Última revisión: 22 Jul 2025

Última actualización: 27 Feb 2025

Acute heart failure is a clinical syndrome of reduced cardiac output, tissue hypoperfusion, increased pulmonary pressure, and tissue congestion.

Presents with dyspnea, decreased exercise tolerance, swelling of the legs, fatigue, and generalized weakness.

Clinical diagnosis is supported by ancillary tests such as ECG, chest x-ray, B-type natriuretic peptide, and echocardiogram. In cases where echocardiographic images are suboptimal or when an unusual cause of heart failure is suspected, and for diagnosis of specific cardiomyopathies, other tests (e.g., cardiac catheterization with hemodynamic measurements, computed tomography, and cardiac magnetic resonance imaging) are used.

Diuretics, oxygen, and vasodilators are initial treatments for symptom relief. Cardiogenic shock may require vasoactive agents, mechanical ventilation, or mechanical circulatory support.

If acute myocardial infarction is present, early revascularization is essential.

Underlying cause or precipitant should be identified and treated.

Definición

Heart failure is defined clinically as a syndrome in which patients have symptoms and signs resulting from an abnormality of cardiac structure and/or function causing impairment of ventricular filling or ejection of blood.[1][2] Acute heart failure refers to rapid onset or worsening of symptoms and/or signs of heart failure, requiring urgent evaluation and treatment.[1]

Anamnesis y examen

Principales factores de diagnóstico

older age
positive past medical history
dyspnea
pulmonary crepitations
peripheral edema
cool peripheries
chest pain
third heart sound (S3)

Todos los datos

Otros factores de diagnóstico

fatigue and weakness or decreased exercise tolerance
hypotension
tachycardia
elevated jugular venous pressure
displaced apex beat (point of maximal impulse)
dullness to percussion and decreased air entry in lung bases
wheezing
palpitations
cough
syncope
murmur
ascites
hepatomegaly
central cyanosis

Todos los datos

Factores de riesgo

older age
prior episode of heart failure
coronary artery disease
hypertension
valvular heart disease
pericardial disease
myocarditis
cardiac arrhythmias
atrial fibrillation
diabetes mellitus
nonadherence to medications
excessive salt intake
excessive catecholamine stimulation
abnormal thyroid function
excessive alcohol intake
obesity

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

ECG
chest x-ray
Hb
thyroid function test
B-type natriuretic peptide
troponin
echocardiography
electrolyte panel with BUN, serum creatinine, glucose
lipid profile
liver function tests

Todos los datos

Pruebas diagnósticas que deben considerarse

lung ultrasound
cardiac catheterization
endomyocardial biopsy
cardiac magnetic resonance (CMR)
nuclear medicine imaging
cardiac CT (coronary CT angiogram)
additional biomarkers

Todos los datos

Algoritmo de tratamiento

Agudo

hemodynamically stable

hypotensive (systolic BP <90 mmHg)

hypertensive crisis

En curso

acute episode stabilized: LVEF <50%

acute episode stabilized: LVEF ≥50%

Colaboradores

Consejeros especializados

Syed Wamique Yusuf, MBBS, FACC, FRCPI

Professor of Medicine

Department of Cardiology

University of Texas

MD Anderson Cancer Center

Houston

Divulgaciones

SWY declares that he was a co-director of the American College of Cardiology (ACC) Cardiovascular Board Review Course during which he had also delivered lectures.

Agradecimientos

Dr Syed Wamique Yusuf would like to gratefully acknowledge Dr Daniel Lenihan, a previous contributor to this topic.

Divulgaciones

DL declares that he has no competing interests.

Revisores por pares

Amal Mattu, MD

Professor of Medicine

Department of Emergency Medicine

University of Maryland School of Medicine

Baltimore

Divulgaciones

AM declares that he has no competing interests.

David Whellan, MD

Assistant Professor of Medicine

Jefferson Medical College

Philadelphia

Divulgaciones

DW declares that he has no competing interests.

Katherine C. Wu, MD

Assistant Professor of Medicine

Johns Hopkins University School of Medicine

Baltimore

Divulgaciones

KCW declares that she has no competing interests.

Sanjay Sharma, BSc (Hons), FRCP (UK), MD

Consultant Cardiologist

King's College Hospital London

London

Divulgaciones

SS declares that he has no competing interests.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-726.Texto completo Resumen

Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 May 3;145(18):e895-1032.Texto completo Resumen

Ezekowitz JA, O'Meara E, McDonald MA, et al. 2017 comprehensive update of the Canadian Cardiovascular Society guidelines for the management of heart failure. Can J Cardiol. 2017 Nov;33(11):1342-433.Texto completo Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
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Guías de práctica clínica
- 2023 focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure
- 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure
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Videos
Central venous catheter insertion: animated demonstration
How to perform an ECG: animated demonstration
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Acute heart failure

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

hemodynamically stable

hypotensive (systolic BP <90 mmHg)

hypertensive crisis

acute episode stabilized: LVEF <50%

acute episode stabilized: LVEF ≥50%

Colaboradores

Consejeros especializados

Syed Wamique Yusuf, MBBS, FACC, FRCPI

Divulgaciones

Agradecimientos

Divulgaciones

Revisores por pares

Amal Mattu, MD

Divulgaciones

David Whellan, MD

Divulgaciones

Katherine C. Wu, MD

Divulgaciones

Sanjay Sharma, BSc (Hons), FRCP (UK), MD

Divulgaciones

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Videos

Folletos para el paciente

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice