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DEFINITION

Heart failure can be defined as an abnormality of cardiac

structure or function leading to failure of the heart to
deliver oxygen at a rate commensurate with the
requirements of the metabolizing tissues

Acute heart failure is defined as the rapid onset of

symptomsand signs secondary to abnormal cardiac function.
It may occur with or without previous cardiac disease. The
cardiac dysfunction can be related to systolic or diastolic
dysfunction, to abnormalities in cardiac rhythm, or to preload and after-load mismatch.

EPIDEMIOLOGY
Approximately 12% of the adult population in developed
countries has HF, with the prevalence rising to 10% among
persons 70 years of age or older.

CLASSIFICATION
New York Heart Association functional classification based on
severity of symptoms and physical activity
Class I No limitation of physical activity. Ordinary physical activity
does not cause undue breathlessness, fatigue, or palpitations.
Class II Slight limitation of physical activity. Comfortable at rest,
but ordinary physical activity results in undue breathlessness,
fatigue, or palpitations.
Class III Marked limitation of physical activity. Comfortable at rest,
but less than ordinary physical activity results in undue
breathlessness, fatigue, or palpitations.
Class IV Unable to carry on any physical activity without
discomfort. Symptoms at rest can be present. If any physical
activity is undertaken, discomfort is increased.

PATHOPHYSIOLOGY OF AHF

The vicious circle in the acute failing heart

Myocardial stunning
Hibernation

DIAGNOSE

SIGN AND SIMPTOM

Symptoms

Signs

Typical

More Specific

Breathlessness

Elevated jugular Venous Pressure

Orthopnoea

Hepatojugular reflux

Paroxysmal nocturnal dyspnoae

Third Heart Sound (gallop rhythm)

Reduced exercise tolerance

Laterally displaced apical impulse

Fatigue, tiredness, increased time Cardiac murmur

to recover after exercise
Ankle swelling

Less typical

Less spesific

Nocturnal cough

Peripheral oedem

Wheezing

Pulmunary crepitations

Weight gain (>2kg/week)

Reduced air entry and dullness to

precussion at lung bases (plueral
effusion)

Weight loss

Tachycardia

Bloated feeling

Irreguler pulse

Loss of appetice

Tachypnoea

Confusion

Hepatomegaly

Depression

Ascites

Palpitation

Tissue wasting

Syncope

MOST COMMON ABNORMALITIES ON THE

ELECTROCARDIOGRAM IN HEART FAILURE

LABORATORY TEST IN PATIENT HOSPITALIZED WITH AHF

Blood count

Always

Platelet count

Always

INR

If patient anticoagulated or in
severe heart failure

CRP

Always

D-dimer

Always (may be falsely positiveif

CRP elevated or patient has been
hospitalized forprolonged period)

Urea and Electrolytes(Na,

K, Urea, Creatinine)

Always

Blood glucose

Always

CKMB, cardiac TnI/TnT

Always

Arterial blood gases

In severe heart failure, or in

diabetic patients

Transaminases

To be considered

Urinanalysis

To be considered

Plasma BNP or NTproBNP

To be considered

TREATMENT
The goals of treatment in patients with established HF are to
relieve symptoms and signs (e.g. oedema), prevent hospital
admission,and improve survival. Although the focus of
clinical trials waspreviously mortality, it is now recognized
that preventing HFhospitalization is important for patients
and healthcare systems.

Angiotensin converting enzyme (ACE)-inhibitors

Diuretics
-blocker
Digoxin and other digitalis glycosides
Vasodilators

COMPLICATION

Coronary artery disease

Valvular disease
Aortic dissection
Renal failure
Pulmonary diseases and bronchoconstriction

PROGNOSIS
Many variables provide prognostic information, although most
of this can be obtained from readily available data such as
age, aetiology, NYHA class, EF, key co-morbidities (renal
dysfunction, diabetes, anaemia, hyperuricaemia), and
plasma natriuretic peptide concentration.
Patients with AHF have a very poor prognosis.

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