Heart%20failure%20-%20acute Signs and Symptoms

Signs and Symptoms

Introduction

Heart Failure

A clinical syndrome caused by functional or structural impairment of ventricular filling or blood ejection
Characterized by either left ventricular hypertrophy or dilation or both

Definition

Acute Heart Failure

Rapid or gradual onset of or change in the signs and/or symptoms of heart failure
Arises as a result of acute cardiac function deterioration in patients previously diagnosed with heart failure or may also be the first presentation of heart failure
- Acute heart failure arising from decompensation of chronic heart failure is associated with arrhythmia, uncontrolled hypertension, infection and noncompliance with therapy and diet
Cardiac dysfunction may be related to ischemia, arrhythmia, valvular abnormalities, pericardial disease, myocarditis, cardiomyopathy, increased filling pressure or elevated systemic resistance
Characterized by pulmonary congestion, decreased cardiac output and tissue hypoperfusion
- Most acute heart failure patients present with normal or high blood pressure and signs and/or symptoms of congestion instead of low cardiac output
Life-threatening condition that needs immediate medical attention
May be transient and reversible with resolution of the acute syndrome or may induce permanent damage leading to chronic heart failure

Etiology

Causes of Acute Heart Failure

Acute coronary syndrome or its complications (eg rupture of interventricular septum, mitral valve chordal rupture, right ventricular infarction, acute mitral regurgitation)
Hypertensive crisis or uncontrolled hypertension
Tachyarrhythmia (eg atrial fibrillation, ventricular tachycardia), severe bradycardia or conduction abnormalities
Pulmonary embolism
Infection (eg infective endocarditis, pneumonia, sepsis)
Pericardial tamponade
Aortic dissection
Surgery and perioperative problems
Peripartum or stress-related cardiomyopathy
Chronic obstructive pulmonary disease (COPD) exacerbation
Cerebrovascular insult
Worsening renal failure
Electrolyte disturbances
Noncompliance to diet or drug therapy
Medications (nonsteroidal anti-inflammatory drugs [NSAIDs], steroids, cardiotoxic chemotherapeutics, negative inotropic agents)
High output states (eg severe anemia, thyrotoxicosis)
Fluid overload (eg volume overload causing pulmonary edema in acute kidney injury, iatrogenic causes)
Toxic substances (recreational drugs, alcohol)

Signs and Symptoms

Heart failure leads to neurohormonal and circulatory abnormalities producing the following manifestations:
- Breathlessness/dyspnea at rest or on exertion
- Decreased exercise capacity or increased time to recover after exercise
- Unexplained fatigue, tiredness
- Orthopnea
- Bendopnea
- Paroxysmal nocturnal dyspnea (PND) or nocturnal cough
- Cough or wheezing
- Palpitations
- Anorexia, nausea, vomiting, abdominal pain, bloated feeling, early satiety, ascites
- Peripheral edema, ankle swelling
- Confusion, disorientation, cognitive decline
- Weakness, depression (especially in the elderly)
- Weight gain (>2 kg/week)
- Weight loss (in advanced heart failure)
- Syncope
More specific signs typical of heart failure include elevated jugular venous pressure, hepatojugular reflux, apical impulse that is laterally displaced and presence of S3 (gallop rhythm)

Once-weekly GLP-1 receptor agonists in T2DM: Metabolic control with cardiovascular benefit

11 Apr 2022

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiorenal events. The REWIND trial aimed to assess the impact of dulaglutide on cardiovascular outcomes in T2DM patients with increased cardiovascular risk. As part of an Eli Lilly-sponsored virtual event held in September 2021, Professor Alice Pik-Shan Kong (The Chinese University of Hong Kong) presented the main results of the REWIND trial.

SGLT2 inhibitors slow CKD progression, may delay dialysis

Prof. Kai-Uwe Eckardt, 13 Oct 2023

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been dubbed “surprise blockbusters” because of their paradigm-shifting cardiorenal benefits in chronic kidney disease (CKD). At an industry-sponsored symposium during the 18^th Congress of Asian Society of Transplantation (CAST 2023), Professor Kai-Uwe Eckardt of the Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Germany, reviewed findings from randomized controlled trials (RCTs) and a recent meta-analysis showing reductions in risk of kidney disease progression and acute kidney injury (AKI) associated with these agents. He also discussed how these effects potentially delay the need for dialysis and kidney transplantation.

TICO backs ticagrelor alone in ACS post-PCI

Pearl Toh, 23 Apr 2020

Taking ticagrelor alone — and dropping aspirin — after 3 months of DAPT* post-PCI** significantly reduced bleeding events without increasing the risk of ischaemic adverse events compared with continuing a DAPT of ticagrelor plus aspirin, the TICO*** trial has shown.