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Treatment of acute decompensated heart failure

INTRODUCTION

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, generally associated with rapid accumulation of fluid within the lung's interstitial and alveolar spaces, which is the result of acutely elevated cardiac filling pressures (cardiogenic pulmonary edema) [1]. ADHF can also present as elevated left ventricular filling pressures and dyspnea without pulmonary edema.

ADHF is most commonly due to left ventricular (LV) 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 cardiogenic 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, particularly renovascular hypertension, and severe renal disease.

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 [1]. This disorder is discussed elsewhere. (See "Noncardiogenic pulmonary edema".)

General issues related to the management of ADHF in patients with and without acute myocardial infarction (MI) will be reviewed here. The pathophysiology and evaluation of patients with ADHF is presented separately. (See "Evaluation of acute decompensated heart failure".)

Treatment of ADHF and cardiogenic shock in the setting of acute coronary syndrome is 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 "Treatment and prognosis of cardiogenic shock complicating acute myocardial infarction-I" and (see "Right ventricular myocardial infarction".
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