Acute heart failure

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Última revisão: 20 Aug 2025

Última atualização: 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.

Определение

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]

Анамнез и осмотр

Ключевые диагностические факторы

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

Полная информация

Другие диагностические факторы

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

Полная информация

Факторы риска

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

Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

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

Полная информация

Исследования, проведение которых нужно рассмотреть

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

Полная информация

Алгоритм лечения

Острый

hemodynamically stable

hypotensive (systolic BP <90 mmHg)

hypertensive crisis

ПРОДОЛЖЕНИЕ

acute episode stabilized: LVEF <50%

acute episode stabilized: LVEF ≥50%

Составители

Эксперты-консультанты

Syed Wamique Yusuf, MBBS, FACC, FRCPI

Professor of Medicine

Department of Cardiology

University of Texas

MD Anderson Cancer Center

Houston

Раскрытие информации

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.

Выражение благодарностей

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

Раскрытие информации

DL declares that he has no competing interests.

Рецензенты

Amal Mattu, MD

Professor of Medicine

Department of Emergency Medicine

University of Maryland School of Medicine

Baltimore

Раскрытие информации

AM declares that he has no competing interests.

David Whellan, MD

Assistant Professor of Medicine

Jefferson Medical College

Philadelphia

Раскрытие информации

DW declares that he has no competing interests.

Katherine C. Wu, MD

Assistant Professor of Medicine

Johns Hopkins University School of Medicine

Baltimore

Раскрытие информации

KCW declares that she has no competing interests.

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

Consultant Cardiologist

King's College Hospital London

London

Раскрытие информации

SS declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

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.Полный текст Аннотация

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.Полный текст Аннотация

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.Полный текст Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия
- Pneumonia
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Рекомендации
- 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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Использование этого контента попадает под действие нашего заявления об отказе от ответственности

Acute heart failure

Resumo

Определение

Анамнез и осмотр

Ключевые диагностические факторы

Другие диагностические факторы

Факторы риска

Диагностические исследования

Исследования, которые показаны в первую очередь

Исследования, проведение которых нужно рассмотреть

Алгоритм лечения

hemodynamically stable

hypotensive (systolic BP <90 mmHg)

hypertensive crisis

acute episode stabilized: LVEF <50%

acute episode stabilized: LVEF ≥50%

Составители

Эксперты-консультанты

Syed Wamique Yusuf, MBBS, FACC, FRCPI

Раскрытие информации

Выражение благодарностей

Раскрытие информации

Рецензенты

Amal Mattu, MD

Раскрытие информации

David Whellan, MD

Раскрытие информации

Katherine C. Wu, MD

Раскрытие информации

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

Раскрытие информации

Peer reviewer acknowledgements

Disclosures

Список литературы

Основные статьи

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия

Рекомендации

Videos

Лифлеты для пациента

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись, чтобы получить полноценный доступ к BMJ Best Practice