Acute heart failure

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Última revisão: 9 Dec 2025

Última atualização: 07 Jan 2026

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.

Definição

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]

História e exame físico

Principais fatores diagnósticos

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

Detalhes completos

Outros fatores diagnósticos

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

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

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

Detalhes completos

Investigações a serem consideradas

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

Detalhes completos

Algoritmo de tratamento

AGUDA

hemodynamically stable

hypotensive (systolic BP <90 mmHg)

hypertensive crisis

CONTÍNUA

acute episode stabilized: LVEF <50%

acute episode stabilized: LVEF ≥50%

Colaboradores

Consultores especialistas

Syed Wamique Yusuf, MBBS, FACC, FRCPI

Professor of Medicine

Department of Cardiology

University of Texas

MD Anderson Cancer Center

Houston

Declarações

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.

Agradecimentos

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

Declarações

DL declares that he has no competing interests.

Revisores

Amal Mattu, MD

Professor of Medicine

Department of Emergency Medicine

University of Maryland School of Medicine

Baltimore

Declarações

AM declares that he has no competing interests.

David Whellan, MD

Assistant Professor of Medicine

Jefferson Medical College

Philadelphia

Declarações

DW declares that he has no competing interests.

Katherine C. Wu, MD

Assistant Professor of Medicine

Johns Hopkins University School of Medicine

Baltimore

Declarações

KCW declares that she has no competing interests.

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

Consultant Cardiologist

King's College Hospital London

London

Declarações

SS declares that he has no competing interests.

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Referências

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Principais artigos

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 Resumo

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 Resumo

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 Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Differentials
- Pneumonia
- Pulmonary embolism
- Asthma
Mais Diagnósticos diferenciais
Guidelines
- 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
Mais Guidelines
Videos
Central venous catheter insertion: animated demonstration
How to perform an ECG: animated demonstration
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Patient information
Atrial fibrillation
Atrial fibrillation: what is it?
More Patient information
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Acute heart failure

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

hemodynamically stable

hypotensive (systolic BP <90 mmHg)

hypertensive crisis

acute episode stabilized: LVEF <50%

acute episode stabilized: LVEF ≥50%

Colaboradores

Consultores especialistas

Syed Wamique Yusuf, MBBS, FACC, FRCPI

Declarações

Agradecimentos

Declarações

Revisores

Amal Mattu, MD

Declarações

David Whellan, MD

Declarações

Katherine C. Wu, MD

Declarações

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

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Differentials

Guidelines

Videos

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice