Treatment of acute decompensated heart failure: General considerations
- Wilson S Colucci, MD
Wilson S Colucci, MD
- Section Editor — Heart Failure
- Professor of Medicine
- Boston University School of Medicine
- Section Editors
- Stephen S Gottlieb, MD
Stephen S Gottlieb, MD
- Section Editor — Heart Failure
- Professor of Medicine
- University of Maryland School of Medicine
- James Hoekstra, MD
James Hoekstra, MD
- Section Editor — Adult Cardiology Emergencies
- Professor and Fredrick Glass Chair
- Wake Forest University
Acute decompensated heart failure (ADHF) is a common and potentially fatal cause of acute respiratory distress. The clinical syndrome is characterized by the development of dyspnea, often associated with accumulation of fluid within the lung's interstitial and alveolar spaces, which is the result of acutely elevated cardiac filling pressures (cardiogenic pulmonary edema) . ADHF can also present as elevated left ventricular filling pressures and dyspnea without pulmonary edema.
ADHF is most commonly due to left ventricular systolic or diastolic dysfunction, with or without additional cardiac pathology, such as coronary artery disease or valve abnormalities. However, a variety of conditions or events can cause pulmonary edema due to an elevated pulmonary capillary wedge pressure in the absence of heart disease, including primary fluid overload (eg, due to blood transfusion), severe hypertension, and severe renal disease.
General considerations related to the management of ADHF in patients with and without acute myocardial infarction (MI) will be reviewed here. The components of therapy of ADHF and the pathophysiology and evaluation of patients with ADHF are presented separately. (See "Treatment of acute decompensated heart failure: Components of therapy" and "Evaluation of acute decompensated heart failure".)
Treatment of ADHF and cardiogenic shock in the setting of acute coronary syndrome are discussed separately. Management of right ventricular MI, which typically presents with hypotension and clear lungs, is also discussed separately. (See "Treatment of acute decompensated heart failure in acute coronary syndromes" and "Prognosis and treatment of cardiogenic shock complicating acute myocardial infarction" and "Right ventricular myocardial infarction".)
Noncardiogenic pulmonary edema is a distinct clinical syndrome associated with diffuse filling of the alveolar spaces in the absence of elevated pulmonary capillary wedge pressure . This disorder is discussed elsewhere. (See "Noncardiogenic pulmonary edema".)
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- MAJOR SOCIETY GUIDELINES
- Inpatient monitoring
- - Documentation of effective diuresis
- Hemodynamic monitoring
- TREATMENT GOALS FOR ACUTE VERSUS CHRONIC HF
- SYSTOLIC VERSUS DIASTOLIC DYSFUNCTION
- ARRHYTHMIA MANAGEMENT
- Atrial fibrillation
- Ventricular arrhythmia
- RENOVASCULAR HYPERTENSION
- PREDICTORS OF OUTCOME
- DISCHARGE FROM HOSPITAL
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS