Definition
Also known as acute cardiac failure. An acute insult to the heart (see causes below), which normally acts by pumping blood around the body, results in failure of the pumping action and low cardiac output (low blood circulation around the body ) and a low blood pressure, inadequate for the body's requirements.
Acute heart failure may be due to left sided heart failure (Left Ventricular Failure), right sided heart failure or a combination of left and right known as congestive cardiac failure (CCF)
Incidence
Incidence increases with age and the prognosis is worse the older the patient is. In the UK and Ireland cardiac failure accounts for 5% of all hospital admissions.
Causes
There is a long list of potential causes of acute cardiac failure. Those listed below include some of the more common causes but this list is by know means exhaustive:
- Coronary artery disease e.g. furring of the arteries.
- High Blood Pressure.
- Heart valve disease.
- Diseases of the heart muscle itself, e.g. cardiomyopathy.
- Infections, either viral or bacterial.
- Some chemotherapy drugs.
- Toxins such as alcohol.
- Radiation induced fibrosis of the heart muscle which occasionally occurs in patients post radiotherapy.
- Inherited condition.
- Some very rare nutritional deficiencies.
Symptoms
Depend on the severity of the insult/damage and whether the left or right side of the heart is affected. Most common symptoms of left sided heart failure: fatigue shortness of breath with reduced exercise tolerance, orthopnoea (inability to lie flat in bed and requiring 3-4 pillows to avoid becoming breathless), paroxysmal nocturnal dyspnoea (sudden awakening with severe breathlessness), nocturnal cough, nocturia (frequent nightly voiding of urine).
If the patient has a component of right sided failure to a greater or lesser degree the symptoms may include: peripheral oedema (ankles, legs up to thighs), ascites (fluid in abdomen with increased girth), pain tender over liver (congested), nausea , anorexia.
Treatment
The treatment of heart failure includes best rest, diurtics such as Frusemide and medications such as Digoxin which increases the heart's effectiveness at pumping blood. In patients with acute heart failure, treatment is commenced with diuretics and drugs called nitrates that reduce the strain of the heart.
Patients' fluid input and output is monitored regularly to make sure that the patient is not becoming dehydrated following administration of diuretics.
Management after acute treatment
Often the cause is not obvious and needs to be investigated. This will be done by an echocardiogram if necessary.
Chronic Heart Failure
Unfortunately there is a gradual deterioration in people with this condition and the 5 year mortality from the larger study is 60% for men and 40% for women.
Outcome
The 5-year mortality from the largest studies is ~ 60% for men and 40% for women
Written by Medpages Editorial Team
Last Editorial Review:20/1/2010
