Acute Heart Failure
“Acute heart failure covers a wide spectrum of illness, ranging from a gradual increase in leg swelling, shortness of breath, or decreased exercise tolerance to the abrupt onset of pulmonary edema.”1
“A clinically useful definition of heart failure is as follows: a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. The cardinal manifestations of heart failure are dyspnea and fatigue, which may limit exercise tolerance, and fluid retention, which may lead to pulmonary and/or splanchnic congestion and/or peripheral edema.”1 (Acute Pulmonary Edema + Podcast)
A simple way to classify heart failure (HF) is to split it into ‘systolic’ or ‘diastolic’ dysfunction based on the ejection fraction (EF).
- Systolic Dysfunction (or HR with reduced EF):
- “defined as an ejection fraction <50%. Mechanistically, the ventricle has difficulty ejecting blood…”1
- Diastolic Dysfunction (or HF with preserved EF):
- “characterized by impaired ventricular relaxation, causing an abnormal relation between diastolic pressure and volume.”1
A complete approach to acute heart failure includes the ability to recognize and manage the presenting symptoms, while determining the precipitating factor (ACS, atrial fibrillation, increased sodium intake, etc.) in order to help prevent further deterioration.
Click HERE for a list of all mentioned FOAM resources.
- Collins, Sean P., and Alan B. Storrow.. “Chapter 53 – Acute Heart Failure.” Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016.
Prepared by Alex Mungham PGY1 FM – University of Ottawa