Acute heart failure

Last reviewed: 7 Jun 2022
Last updated: 20 Apr 2022

Summary

Definition

History and exam

Key diagnostic factors

  • age >70 years
  • positive past medical history
  • dyspnea
  • pulmonary crepitations
  • peripheral edema
  • cool peripheries
  • chest pain
  • third heart sound (S3)
More key diagnostic factors

Other diagnostic factors

  • 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
  • fever
  • syncope
  • murmur
  • ascites
  • hepatomegaly
  • central cyanosis
Other diagnostic factors

Risk factors

  • age >70 years
  • prior episode of heart failure
  • coronary artery disease
  • hypertension
  • valvular heart disease
  • pericardial disease
  • myocarditis
  • atrial fibrillation
  • diabetes mellitus
  • nonadherence to medications
  • excessive salt intake
  • excessive catecholamine stimulation
  • abnormal thyroid function
  • excessive alcohol intake
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • chest x-ray
  • Hb
  • thyroid function test
  • troponin
  • B-type natriuretic peptide
  • echocardiography
More 1st investigations to order

Investigations to consider

  • cardiac catheterization
  • endomyocardial biopsy
  • cardiac magnetic resonance (CMR)
  • single-photon emission CT
  • positron emission tomography with or without CT
  • cardiac CT (coronary CT angiogram)
  • additional biomarkers
More investigations to consider

Treatment algorithm

ACUTE

hemodynamically stable

hypotensive (systolic BP <90 mmHg)

hypertensive crisis

ONGOING

acute episode stabilized: LVEF <50% and systolic BP >100 mmHg

acute episode stabilized: LVEF <50% and systolic BP 90-100 mmHg

acute episode stabilized: LVEF ≥50%

Contributors

Authors

Syed Wamique Yusuf, MBBS, FACC, FRCPI
Syed Wamique Yusuf

Professor of Medicine

Department of Cardiology

University of Texas

MD Anderson Cancer Center

Houston

TX

Disclosures

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

Acknowledgements

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

Disclosures

DL declares that he has no competing interests.

Peer reviewers

David Whellan, MD

Assistant Professor of Medicine

Jefferson Medical College

Philadelphia

PA

Disclosures

DW declares that he has no competing interests.

Katherine C. Wu, MD

Assistant Professor of Medicine

Johns Hopkins University School of Medicine

Baltimore

MD

Disclosures

KCW declares that she has no competing interests.

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

Consultant Cardiologist

King's College Hospital London

London

UK

Disclosures

SS declares that he has no competing interests.

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