Acute Decompensated Heart Failure

Overview

Acute decompensated heart failure is an acute or worsening syndrome of congestion and/or impaired cardiac output.

Patients may deteriorate because of infection, ischemia, arrhythmia, uncontrolled hypertension, medication non-adherence, or other precipitants.

Clinical Assessment

Determine whether the patient is predominantly congested, hypoperfused, or both.

Look for pulmonary edema, raised JVP, peripheral edema, hypotension, cool extremities, altered mental status, and reduced urine output.

Investigation

ECG, chest imaging, blood tests, natriuretic peptides, echocardiography, and targeted investigation for the precipitating cause may be required.

Management

Management includes treatment of congestion, optimization of oxygenation and ventilation when required, correction of precipitating factors, and circulatory support when perfusion is severely impaired.

The first priority is stabilization while simultaneously identifying the precipitant.

Clinical Pearls