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Review
. 2015 Apr 24;112(17):298-310.
doi: 10.3238/arztebl.2015.0298.

De novo acute heart failure and acutely decompensated chronic heart failure

Astrid Hummel  1 , Klausn Empe, Marcus Dörr, Stephan B Felix
Affiliations
Review

De novo acute heart failure and acutely decompensated chronic heart failure

Astrid Hummel et al. Dtsch Arztebl Int. .

Abstract

Background: Heart failure is one of the most common diseases of adults in Europe, with an overall prevalence of 1-2%. Among persons aged 60 and above, its prevalence is above 10% in men and 8% in women. Acute heart failure has a poor prognosis; it is associated with a high rate of rehospitalization and a 1-year mortality of 20-30%.

Methods: This review is based on pertinent literature, including guidelines, retrieved by a selective search in PubMed.

Results: There are different types of acute heart failure; the basic diagnostic assessment is performed at once and consists of ECG, echocardiography, and the measurement of N-terminal pro-brain natriuretic peptide (NTproBNP) and troponin levels. The most common causes of decompensation are arrhythmia, valvular dysfunction, and acute cardiac ischemia, each of which accounts for 30% of cases. The potential indication for immediate revascularization should be carefully considered in cases where acute heart failure is due to coronary heart disease. The basic treatment of acute heart failure is symptomatic, with the administration of oxygen, diuretics, and vasodilators. Ino-tropic agents, vasopressors, and temporary mechanical support for the circulatory system are only used to treat cardiogenic shock.

Conclusion: The treatment of acute heart failure is markedly less evidence-based than that of chronic heart failure. Newer treatment approaches that are intended to improve outcomes still need to be tested in multicenter trials.

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Figures

Figure 1
Figure 1
In-hospital mortality as a function of the past history and clinical presentation of acute heart failure (from [5]). ADCHF, acutely decompensated chronic heart failure
Figure 2
Figure 2
Pathophysiology of congestion (from [8]). LVEDP, left-ventricular end-diastolic pressure; PCWP, pulmonary capillary wedge pressure; DNV, distended neck veins;LA pressure, left-atrial pressure
Figure 3
Figure 3
The frequency of clinical subtypes of acute heart failure (from [5])
Figure 4
Figure 4
Diagnostic assessment of patients with suspected acute heart failure (based on the guidelines of the European Society of Cardiology [7])
Figure 5
Figure 5
Treatment algorithm for acute heart failure [from 7] ESICM, European Society of Intensive Care Medicine; ICU, intensive care unit; SpO2, blood oxygen saturation
See this image and copyright information in PMC

Comment in

  • Which Patients Will Benefit?
    Spiliopoulos S, Körfer R, Tenderich G. Spiliopoulos S, et al. Dtsch Arztebl Int. 2016 Jan 22;113(3):39. doi: 10.3238/arztebl.2016.0039a. Dtsch Arztebl Int. 2016. PMID: 26857512 Free PMC article. No abstract available.
  • The Renaissance of Digitoxin Is Overdue.
    Tauchnitz C. Tauchnitz C. Dtsch Arztebl Int. 2016 Jan 22;113(3):39. doi: 10.3238/arztebl.2016.0039b. Dtsch Arztebl Int. 2016. PMID: 26857513 Free PMC article. No abstract available.
  • Rapid Application Is Crucial.
    Hennig F, Potapov EV, Falk V, Krabatsch T. Hennig F, et al. Dtsch Arztebl Int. 2016 Jan 22;113(3):39-40. doi: 10.3238/arztebl.2016.0039c. Dtsch Arztebl Int. 2016. PMID: 26857514 Free PMC article. No abstract available.
  • In Reply.
    Felix SB, Hummel A, Empen K, Dörr M. Felix SB, et al. Dtsch Arztebl Int. 2016 Jan 22;113(3):40. doi: 10.3238/arztebl.2016.0040. Dtsch Arztebl Int. 2016. PMID: 26857515 Free PMC article. No abstract available.

References

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    1. Neumann T, Biermann J, Neumann A, et al. Heart failure: the commonest reason for hospital admission in Germany: medical and economic perspective. Dtsch Arztebl Int. 2009;106:269–275. - PMC - PubMed
    1. Braunwald, E. Heart failure. J Am Coll Cardiol HF. 2013;1:1–20. - PubMed
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    1. Nieminen MS, Brutsaert D, Dickstein K, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006;27:2725–2736. - PubMed

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