Murad Amro _ AHF

1. Acute heart failure
Alexander Goldman MD
Department of Cardiology
Assuta Ashdod MC

2. Definition of heart failure
HF is a clinical syndrome characterized by
typical symptoms (breathlessness, ankle
swelling and fatigue) that may be
accompanied by signs (elevated jugular
venous pressure, pulmonary crackles and
peripheral edema) caused by a structural
and/or functional cardiac abnormality,
resulting in a reduced cardiac output
and/ or elevated intracardiac pressures
at rest or during stress.

4. Epidemiology
• 1–2% of the adult population in developed countries
• ≥10% among people 70 years of age
• lifetime risk of HF at age 55 years is 33% for
men and 28% for women
• proportion of patients with HFpEF ranges from 22 to 73%,
depending on the definition

5. Acute heart failure
• Acute heart failure (AHF) is the term
used to describe the rapid onset of or
acute worsening of symptoms and
signs of HF.
• It is a life-threatening condition that
requires immediate medical attention.
• Evaluation and treatment, typically leading
to urgent hospital admission

6. Acute heart failure
• First occurrence
• More frequently, due to acute
decompensation of chronic heart
failure.
• Primary cardiac dysfunction
• Precipitated by extrinsic factors,
often in patients with chronic HF

8. Clinical Presentation
• Preserved SBP (90–140mmHg)
• Elevated SBP (140 mmHg; hypertensive AHF)
• Only 5–8% of all patients present with
low SBP (i.e. ,90 mmHg; hypotensive AHF),
which is associated with poor prognosis

9. www.escardio.org/guidelines
©ESC
2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
(European Heart Journal 2021 – doi:10.1093/eurheartj/ehab368)
Clinical presentations of acute heart failure
LV = left ventricular; LVEDP = left ventricular end-diastolic pressure; MCS = mechanical circulatory support; PCWP = pulmonary capillary wedge pressure; RV = right ventricular; RVEDP = right
ventricular end-diastolic pressure; RRT = renal replacement therapy; SBP = systolic blood pressure. aMay be normal with low cardiac output. bWet and cold profile with need of inotropes
and/or vasopressors may rarely occur.

10. Management
of acute HF

11. Management
• Initial evaluation and continued non-invasive monitoring:
• pulse oximetry,
• blood pressure,
• respiratory rate
• continuous ECG
• Urine output should also be monitored, although routine
urinary catheterization is not recommended

13. Management
of acute HF
Continued

14. Criteria for hospitalization in
ward vs. ICCU
• Significant dyspnea or hemodynamic
Instability
• High-risk patients (persistent, significant dyspnea,
hemodynamic instability, recurrent arrhythmias, AHF and
associated ACS)

15. Admission
• The criteria for ICU/CCU admission include any of the following:
– need for intubation (or already intubated)
– signs/symptoms of hypoperfusion
– oxygen saturation (SpO2) ,90% (despite supplemental oxygen)
– use of accessory muscles for breathing, respiratory rate >25/min
– heart rate <40 or >130 bpm, SBP <90 mmHg

16. Oxygen therapy and
ventilatory support

17. Early administration of diuretics and
vasodilators
Initially, 20–40
mg intravenous
furosemide can
be considered
in all AHF
patients
In cases of
volume
overload, the
intravenous
diuretic dose
should be
tailored to the
type of AHF (de
novo with a
lower dose than
exacerbation of
CHF)
When systolic BP
is normal to high
(≥110 mmHg),
intravenous
vasodilator
therapy might be
given for
symptomatic
relief as initial
therapy.
Alternatively,
sublingual
nitrates may be
considered.

19. Management of
evidence-based oral
therapies

20. Criteria for discharge
• Hemodynamically stable, euvolemic,
established on evidence-based oral
medication and with stable renal
function for at least 24 hours before
discharge
• Once provided with tailored
education and advice about self-care

21. Role of nursing management in
acute heart failure
• Specific considerations of nursing
management include:
○ Triage to the appropriate environment for
safe clinical care
○ Objective monitoring for a change in signs
and symptoms suggestive of response to
treatment.
○ Discharge planning and referral to a
multidisciplinary disease management
program.
• Anxiety of the patient should be addressed
by promptly answering questions and
providing clear information to the patient and
family
• Relevant changes in clinical status should be
promptly addressed and communicated to the
physician.
• Effective and consistent communication
should be maintained with the patient and/or