- The patient presented with acute decompensated heart failure (ADHF), characterized by acute dyspnea and accumulation of fluid in the lungs.
- An evaluation was performed which included physical exam, chest x-ray, ECG, lab tests, and echocardiogram to diagnose ADHF and identify potential precipitating factors such as nonadherence, infection, arrhythmias, or myocardial ischemia.
- Invasive hemodynamic monitoring with a Swan-Ganz catheter is not routinely recommended but may help in select cases to guide management of worsening renal function or need for advanced therapies.
heart failure otherwise called congestive heart failure. causes of this is diabetes Mellitus, hypertension, excess intake of fat, stress, prevention of this according to the doctor's order take the medicine, follow a diet plan, without sodium, alcohol, should be avoided.then we free from congestive heart failure .
DIAGNOSIS & MANAGEMENT OF PULMONARY HYPERTENSIONKamal Bharathi
Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure ≥25 mm Hg at rest, measured during right heart catheterization. There is still insufficient evidence to add an exercise criterion to this definition. The term pulmonary arterial hypertension (PAH) describes a subpopulation of patients with PH characterized hemodynamically by the presence of pre-capillary PH including an end-expiratory pulmonary artery wedge pressure (PAWP) ≤15 mm Hg and a pulmonary vascular resistance >3 Wood units. Right heart catheterization remains essential for a diagnosis of PH or PAH. This procedure requires further standardization, including uniformity of the pressure transducer zero level at the midthoracic line, which is at the level of the left atrium. One of the most common problems in the diagnostic workup of patients with PH is the distinction between PAH and PH due to left heart failure with preserved ejection fraction (HFpEF). A normal PAWP does not rule out the presence of HFpEF. Volume or exercise challenge during right heart catheterization may be useful to unmask the presence of left heart disease, but both tools require further evaluation before their use in general practice can be recommended. Early diagnosis of PAH remains difficult, and screening programs in asymptomatic patients are feasible only in high-risk populations, particularly in patients with systemic sclerosis, for whom recent data suggest that a combination of clinical assessment and pulmonary function testing including diffusion capacity for carbon monoxide, biomarkers, and echocardiography has a higher predictive value than echocardiography alone.
heart failure otherwise called congestive heart failure. causes of this is diabetes Mellitus, hypertension, excess intake of fat, stress, prevention of this according to the doctor's order take the medicine, follow a diet plan, without sodium, alcohol, should be avoided.then we free from congestive heart failure .
DIAGNOSIS & MANAGEMENT OF PULMONARY HYPERTENSIONKamal Bharathi
Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure ≥25 mm Hg at rest, measured during right heart catheterization. There is still insufficient evidence to add an exercise criterion to this definition. The term pulmonary arterial hypertension (PAH) describes a subpopulation of patients with PH characterized hemodynamically by the presence of pre-capillary PH including an end-expiratory pulmonary artery wedge pressure (PAWP) ≤15 mm Hg and a pulmonary vascular resistance >3 Wood units. Right heart catheterization remains essential for a diagnosis of PH or PAH. This procedure requires further standardization, including uniformity of the pressure transducer zero level at the midthoracic line, which is at the level of the left atrium. One of the most common problems in the diagnostic workup of patients with PH is the distinction between PAH and PH due to left heart failure with preserved ejection fraction (HFpEF). A normal PAWP does not rule out the presence of HFpEF. Volume or exercise challenge during right heart catheterization may be useful to unmask the presence of left heart disease, but both tools require further evaluation before their use in general practice can be recommended. Early diagnosis of PAH remains difficult, and screening programs in asymptomatic patients are feasible only in high-risk populations, particularly in patients with systemic sclerosis, for whom recent data suggest that a combination of clinical assessment and pulmonary function testing including diffusion capacity for carbon monoxide, biomarkers, and echocardiography has a higher predictive value than echocardiography alone.
Cardiology: Treatment of Heart FailureVedica Sethi
Abstract Heart Failure (HF) is the most widely recognized cardiovascular disorder behind medical clinic affirmation for individuals more established than 60 years old. Hardly any regions in medication have advanced as surprisingly as HF treatment in the course of recent decades. Be that as it may, progress has been reliable just for ceaseless HF with diminished discharge part. In intensely decompensated HF and HF with safeguarded discharge part, none of the medications tried to date have been conclusively demonstrated to improve endurance. Deferring or forestalling HF has gotten progressively significant in patients who are inclined to HF. The anticipation of declining interminable HF and hospitalisations for intense decompensation is likewise critical. The target of this paper is to give a compact and down to earth rundown of the accessible medication medicines for HF. The most ideal proof based medication treatment (counting inhibitors of the renin–angiotensin– aldosterone framework and β blockers) is helpful just when ideally actualized. Notwithstanding, usage may be testing. To accept that ailment the executives projects can be useful in giving a multidisciplinary, comprehensive way to deal with the conveyance of ideal clinical consideration. Keywords; heart failure, multidisciplinary approach, Beat-blocker, RAAS framework
Role of Clinical Pharmacist in Management of Congestive Heart Failure – A Bri...BRNSS Publication Hub
Heart failure (HF) is a clinical condition occurs when cardiac output is insufficient to meet the demands of tissue perfusion or does so by elevating filling pressure. HF is due to either systolic or diastolic dysfunction which reduces ventricular filling (diastolic dysfunction) and/or myocardial contractility (systolic dysfunction). Clinically, cardiac disease prevalence increases with individual age. Cardiac dysfunction occurs due to change in blood volume, and neurohumoral transmission status these desirable mechanisms to maintain adequate cardiac output and arterial blood pressure. The activation of three compensatory neurohormonal systems triggers the cardiac dysfunction leads to HF. Clinical pharmacist plays a role in disease management by identifying the risk factors, stage of severity, educating the patients and health-care practitioners and implementing the awareness programs, and modification of lifestyle interventions with in health-care system beneficial to the community may reduce the progression of disease severity.
Cardiovascular breakdown (HF) or Congestive Heart Failure (CHF) is a physiologic state wherein the heart can't siphon sufficient blood to meet the body's metabolic requirements following any underlying or useful weakness of ventricular filling or discharge of blood.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
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Stress-induced (takotsubo) cardiomyopathy (See "Stress-induced (takotsubo) cardiomyopathy".)
Cardiotoxic agents such as alcohol, cocaine, and certain chemotherapy drugs.
Right ventricular pacing, which produces dyssynchrony.
Noncardiac
Severe hypertension, which is common in patients with ADHF (see "Epidemiology and causes of heart failure" and "Treatment of hypertension in patients with heart
failure" and "Pathophysiology of cardiogenic pulmonary edema", section on 'Renovascular hypertension').
Renal failure. (See "Diagnostic approach to the patient with acute kidney injury (acute renal failure) or chronic kidney disease".)
Miscellaneous factors such as anemia, hypo- or hyperthyroidism, fever, infection (eg, pneumonia), and uncontrolled diabetes.
Pulmonary emboli. (See "Diagnosis of acute pulmonary embolism".)
"Flash" pulmonary edema — “Flash” pulmonary edema is a dramatic form of ADHF in which acute increases in left ventricular diastolic pressure, often associated with
chronic elevation of diastolic filling pressures, cause rapid fluid accumulation in the pulmonary interstitium and alveolar spaces. “Flash” pulmonary edema may develop in some
patients with myocardial ischemia with or without myocardial infarction, acute severe mitral regurgitation, hypertensive crisis, acute aortic regurgitation and stress-induced
(takotsubo) cardiomyopathy. (See "Treatment of acute decompensated heart failure in acute coronary syndromes" and "Acute mitral regurgitation in adults" and "Treatment of
specific hypertensive emergencies", section on 'Acute pulmonary edema' and "Acute aortic regurgitation in adults" and "Stress-induced (takotsubo) cardiomyopathy".)
Patients with bilateral renal artery stenosis are at increased risk for developing “flash” pulmonary edema; this association was first described by Pickering et al. [7] It has been
named the Pickering syndrome [8] and is an indication for renal artery revascularization. (See "Pathophysiology of cardiogenic pulmonary edema".)
TESTS
Electrocardiogram — The ECG may identify underlying predisposing or precipitating conditions for heart failure such as left ventricular hypertrophy, left atrial abnormalities,
myocardial ischemia or infarction, or the presence of atrial fibrillation (waveform 1). Acute coronary syndrome precipitating ADHF should be promptly identified by
electrocardiogram and cardiac troponin testing and treated as appropriate for the condition and prognosis of the patient with consideration of coronary angiography. (See
"Electrocardiographic diagnosis of left ventricular hypertrophy" and "Electrocardiogram in the diagnosis of myocardial ischemia and infarction" and 'Coronary angiography' below.)
Additional ECG abnormalities may be seen in a patient during an episode of ADHF. These include giant negative T waves, global T wave inversions, and marked QT interval
prolongation. These changes may represent ischemia, which can be the cause or the result of the pulmonary edema. They can also be seen in patients with pulmonary edema
due to noncoronary events, such as cerebrovascular disease. (See "Neurogenic pulmonary edema".)
One report described nine patients with cardiogenic but nonischemic pulmonary edema who developed large inverted T waves with marked QT interval prolongation within 24 hours
of treatment and stabilization [9]. These repolarization abnormalities resolved within one week and were not associated with any in-hospital mortality.
The causes of these ECG changes may include:
Subendocardial ischemia due to increased wall stress, high end-diastolic pressure, or decreased coronary artery flow
An acute increase in cardiac sympathetic tone
An increase in electrical heterogeneity due to underlying myocardial damage or hypertrophy and exacerbated by ischemia, metabolic changes, or catecholamines.
Chest radiography — Radiographic findings in ADHF can range from mild pulmonary vascular redistribution to marked cardiomegaly and extensive bilateral interstitial markings
(image 1A-D). The presence of bilateral perihilar alveolar edema may give the typical "butterfly" appearance [10]. Unilateral cardiogenic pulmonary edema is infrequent (2 percent of
cardiogenic pulmonary edema cases in one study) and is chiefly caused by eccentric mitral regurgitation [11]. Pleural effusions are often absent given the acute nature of the
accumulation of pulmonary edema. A normal chest radiograph does not exclude ADHF [12].
Laboratory data — Initial laboratory data can be obtained but is usually not needed to make the diagnosis or guide initial therapy; treatment should NOT be delayed while waiting
for the results of laboratory tests.
An arterial blood specimen or pulse oximetry can quantify the level of hypoxia if oxygen saturation is low. Arterial blood gas analysis is recommended in all patients with
severe respiratory distress for information on ventilatory and acid-base status [4].
A complete blood count may help identify the presence of infection or anemia that may have precipitated the event.
Routine chemistries may identify renal dysfunction. This may be due in part to a low output state, a setting in which the blood urea nitrogen (BUN) and serum creatinine
concentrations can be used as a marker of cardiac output, or to underlying renal disease, particularly bilateral renal artery stenosis.
If ongoing myocardial ischemia is suspected, cardiac enzymes should be measured to evaluate potential myocardial injury. Troponin is often elevated in ADHF as a result
of subendocardial ischemia, myocyte apoptosis, inflammatory mediator activation, and increased myocardial oxygen demand in the setting of fixed coronary disease.
Therefore, troponin elevation in acute HF does not necessarily indicate the presence of an acute coronary syndrome. (See "Troponins and creatine kinase as biomarkers of
cardiac injury" and "Biomarkers suggesting cardiac injury other than troponins and creatine kinase".)
Diagnostic utility of BNP and NT-proBNP — B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) assays can supplement clinical judgment when the
cause of a patient's dyspnea is uncertain, particularly among patients with an intermediate probability of HF [2,13]. Results should be interpreted in the context of all available
clinical data [14]. (See "Evaluation of the patient with suspected heart failure" and "Natriuretic peptide measurement in heart failure".)
Echocardiography and other imaging modalities — Major society guidelines recommend Doppler echocardiography to aid in the diagnosis and classification of heart failure
[2,4,14,15]. Assessment of ventricular function by echocardiography or other method (eg, radionuclide, CMR, CT, or contrast ventriculography) is helpful in characterizing the type
(systolic versus diastolic), severity, and potential cause of ventricular dysfunction.
When reduced LVEF (<40 percent) is found, the cause of heart failure may be ascribed to systolic dysfunction (with or without other causes such as diastolic dysfunction or
valvular disease) [4]. When preserved left ventricular systolic function is found, the cause of heart failure may be diastolic dysfunction, transient systolic dysfunction, other cause
of heart failure with preserved ejection fraction (table 1), or diagnostic error (no heart failure with symptoms/signs due to another cause).
Two-dimensional and Doppler echocardiography enables evaluation of ventricular size, global and regional systolic function, diastolic function, valvular disease, and pericardial
disease. Echocardiography also enables estimation of right atrial pressure, pulmonary artery pressures and pulmonary capillary wedge pressure. (See "Evaluation of the patient
with suspected heart failure", section on 'Echocardiography' and "Pathophysiology of cardiogenic pulmonary edema".)
In patients with STEMI and pulmonary congestion, echocardiography should be performed urgently to estimate LV and RV function and to exclude a mechanical complication.
(See "Mechanical complications of acute myocardial infarction".)
Swan-Ganz catheter — Available evidence on flow-directed pulmonary artery (Swan-Ganz) catheters in patients with ADHF does not support their routine use. (See
"Management of refractory heart failure", section on 'Hemodynamic monitoring'.) Thus, routine use of invasive hemodynamic monitoring in patients with ADHF is NOT
recommended by the 2010 Heart Failure Society of America or 2013 American College of Cardiology/American Heart Association (ACCF/AHA) guidelines [2,14]. However, the
ACCF/AHA guideline recommends invasive hemodynamic monitoring in patients with acute HF with persistent symptoms and/or when hemodynamics are uncertain [14].
In addition, invasive monitoring can be useful in carefully selected patients with persistent symptoms despite empiric adjustment of standard therapies and one of the following
conditions:
Renal function is worsening with therapy.
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Parenteral vasoactive agents are required, OR
Consideration of advanced device therapy or cardiac transplantation may be required.
A pulmonary capillary wedge pressure ≥18 mmHg favors cardiogenic pulmonary edema. (See "Pulmonary artery catheterization: Indications and complications" and "Pulmonary
artery catheterization: Interpretation of tracings".)
However, it is important to appreciate that pulmonary artery catheterization measurements can be misleading in certain settings. Most important, myocardial ischemia can cause
severe but transient left ventricular dysfunction. If the wedge pressure is first measured after the ischemia has resolved (and if left ventricular function has improved), a relatively
normal value may be obtained, leading to the erroneous conclusion that the respiratory distress was caused by noncardiogenic mechanisms.
On the other hand, an elevated wedge pressure does not exclude the possibility of noncardiogenic pulmonary edema. It is estimated that as many as 20 percent of patients with
pulmonary edema due to acute respiratory distress syndrome (ARDS) have concomitant left ventricular dysfunction. The contribution of ARDS to the pulmonary edema requires
monitoring the wedge pressure response to treatment. Noncardiogenic factors are probable if the pulmonary infiltrates and hypoxemia do not improve appreciably within 24 to 48
hours after normalization of the wedge pressure. (See "Noncardiogenic pulmonary edema".)
In patients with adequate acoustic windows, echocardiography may provide a noninvasive means of estimating filling pressures. (See "Tissue Doppler echocardiography", section
on 'Estimation of LV filling pressures'.)
Coronary angiography — Urgent or early coronary angiography and intervention is indicated in patients with ADHF and an acute coronary syndrome. As recommended in the
2013 ACCF/AHA HF guideline, coronary arteriography is reasonable when ischemia may be contributing to HF [3]. (See "Treatment of acute decompensated heart failure in acute
coronary syndromes" and "Overview of the acute management of ST elevation myocardial infarction" and "Coronary arteriography and revascularization for unstable angina or non-
ST elevation acute myocardial infarction".)
DIFFERENTIAL DIAGNOSIS — Since acute decompensated heart failure (ADHF) frequently presents with the sudden onset of respiratory distress that may or may not be
associated with chest discomfort or a previous history of heart disease, other medical conditions must be excluded:
Pulmonary embolism — The sudden onset of dyspnea, pleuritic chest pain, and cough may reflect a pulmonary embolism (PE). Establishing the diagnosis may depend
upon the characteristics of the ECG and the difference in appearance of typical chest x-ray findings in the two conditions. (See "Diagnosis of acute pulmonary embolism".)
In addition to being part of the differential diagnosis, venous thromboembolism is more common in patients with heart failure and, in patients with ADHF, is associated with
a worse prognosis [16]. (See "Indications for antithrombotic therapy in heart failure".)
Pneumonia — Pneumonia can present with acute shortness of breath, hypoxemia, and an inconclusive pulmonary examination. Chest x-ray findings may be similar to HF
in cases of bibasilar pneumonia or unilateral pulmonary edema. (See "Diagnostic approach to community-acquired pneumonia in adults".)
Asthma — Reactive airways disease can cause acute shortness of breath, cough, and fatigue. In addition, patients with ADHF may present with wheezing that can
simulate asthma. (See "Diagnosis of asthma in adolescents and adults".)
Noncardiogenic pulmonary edema — Causes of noncardiogenic pulmonary include permeability pulmonary edema due to adult respiratory distress syndrome (ARDS) and
other causes such as pulmonary embolism, reperfusion, re-expansion, high altitude, neurogenic, opiate overdose, salicylate toxicity, viral infections, and veno-occlusive
disease. (See "Noncardiogenic pulmonary edema".)
INFORMATION FOR PATIENTS — UpToDate offers two types of patient education materials, “The Basics” and “Beyond the Basics.” The Basics patient education pieces are
written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best
for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more
detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.
Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education
articles on a variety of subjects by searching on “patient info” and the keyword(s) of interest.)
Basics topics (see "Patient information: When your lungs fill with fluid (The Basics)")
SUMMARY AND RECOMMENDATIONS
Acute decompensated heart failure (ADHF) is characterized by the development of acute dyspnea associated with elevated intracardiac filling pressures with or without
pulmonary edema. Heart failure may be new or an exacerbation of chronic disease. (See 'Clinical signs and symptoms' above.) Initial assessment should include a brief,
focused history and physical examination to evaluate signs and symptoms of HF as well as potential contributing factors and comorbidities. (See 'Clinical signs and
symptoms' above.)
Precipitating factors for ADHF include adherence and process of care issues, cardiac and noncardiac disorders. (See 'Identification of precipitating factors' above.)
“Flash” pulmonary edema is a dramatic form of ADHF in which acute increases in left ventricular diastolic pressure cause rapid fluid accumulation in the pulmonary
interstitium and alveolar spaces. (See '"Flash" pulmonary edema' above.)
Acute coronary syndrome precipitating ADHF should be promptly identified by electrocardiogram and cardiac troponin testing and treated as appropriate for the condition
and prognosis of the patient with consideration of coronary angiography. (See 'Electrocardiogram' above.)
B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) assays can supplement clinical judgment when the cause of a patient's dyspnea is uncertain,
particularly among patients with an intermediate probability of HF. (See 'Diagnostic utility of BNP and NT-proBNP' above.)
Routine use of invasive hemodynamic monitoring in patients with ADHF is not recommended. However, invasive hemodynamic monitoring is indicated in patients who are in
respiratory distress or have clinical evidence of hypoperfusion in whom clinical assessment cannot adequately determine intracardiac filling pressures. (See 'Swan-Ganz
catheter' above.)
Urgent or early coronary angiography and intervention is indicated in patients with ADHF and an acute coronary syndrome. (See 'Coronary angiography' above.)
The differential diagnosis of ADHF includes other causes of acute respiratory distress such as pulmonary embolism, pneumonia, and asthma. (See 'Differential diagnosis'
above.)
ACKNOWLEDGMENT — The UpToDate editorial staff would like to thank Dr. Stanley Lewis for his contributions as an author to previous versions of this topic review.
Use of UpToDate is subject to the Subscription and License Agreement.
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15. Arnold JM, Liu P, Demers C, et al. Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: diagnosis and management. Can J
Cardiol 2006; 22:23.
16. Darze ES, Latado AL, Guimarães AG, et al. Acute pulmonary embolism is an independent predictor of adverse events in severe decompensated heart failure patients. Chest
2007; 131:1838.
Topic 3497 Version 10.0
5. 11/5/13 Evaluation of acute decompensated heart failure
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GRAPHICS
Electrocardiogram in a patient with flash pulmonary edema
The ECG tracing reveals left ventricular hypertrophy (LVH) assoicated
with ST segment depression and T wave inversions; these ST-T wave
changes (arrows) may also represent subendocardial ischemia, which
along with the LVH may be responsible for the episode of flash
pulmonary edema.
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Pulmonary edema
This plain frontal chest radiograph of a 55-year-old male with
known coronary artery disease demonstrates characteristic
radiographic features of heart failure with interstitial pulmonary
edema, bilateral perihilar alveolar edema producing a characteristic
butterfly pattern and bilateral pleural effusions.
Photo courtesy of Jonathan Kruskal, MD.
Normal chest radiograph
Posteroanterior view of a normal chest radiograph.
Courtesy of Carol M Black, MD.
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Heart failure
This chest radiograph of a 65-year-old male with dyspnea and
orthopnea demonstrates mild pulmonary vascular congestion,
septal lymphatic distention (white arrow), interstitial veiling, and
enlarged hilar shadows (black arrow), indicative of left ventricular
decompensation.
Courtesy of Jonathan Kruskal, MD.
Normal chest radiograph
Posteroanterior view of a normal chest radiograph.
Courtesy of Carol M Black, MD.
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Severe heart failure
This chest radiography shows severe heart failure with
cardiomegaly, pulmonary vascular congestion with infiltrates in
the mid lung fields (white arrow), and a small pleural effusion
(black arrow).
Courtesy of Jonathan Kruskal, MD.
Normal chest radiograph
Posteroanterior view of a normal chest radiograph.
Courtesy of Carol M Black, MD.
9. 11/5/13 Evaluation of acute decompensated heart failure
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Acute left ventricular failure
This plain frontal radiograph of the chest of a 30-year-old male
demonstrates bilateral perihilar alveolar edema, giving a typical
butterfly appearance, with bilateral interstitial edema and
pulmonary venous redistribution to the upper lobes. The acute
nature of this condition is manifest by the absence of pleural
effusions or an enlarged cardiac silhouette.
Photo courtesy of Jonathan Kruskal, MD.
Normal chest radiograph
Posteroanterior view of a normal chest radiograph.
Courtesy of Carol M Black, MD.
10. 11/5/13 Evaluation of acute decompensated heart failure
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Differential diagnosis of heart failure with preserved left ventricular ejection fraction
Diastolic heart failure
Hypertensive heart disease
Restrictive cardiomyopathy
Infiltrative cardiomyopathies
Hypertrophic cardiomyopathy
Noncompaction cardiomyopathy
Coronary heart disease
Miscellaneous factors: diabetes mellitus, chronic kidney disease, aging
Valvular heart disease
Valvular stenosis
Valvular regurgitation
Right heart failure
Pulmonary hypertension
Right ventricular infarction
Arrhythmogenic right ventricular cardiomyopathy
Pericardial disease
Cardiac tamponade
Constrictive pericarditis
Effusive-constrictive pericardial disease
Intracardiac mass
Atrial myxoma
Congenital heart disease
High-output heart failure
Episodic or reversible LV systolic dysfunction
Pulmonary vein stenosis
Adapted from: Oh JK, Hatle L, Tajik AJ, Little WC. Diastolic heart failure can be diagnosed by comprehensive two-dimensional and Doppler echocardiography. J Am
Coll Cardiol 2006; 47:500.