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Review
. 2018 May;33(3):462-473.
doi: 10.3904/kjim.2017.355. Epub 2018 Apr 11.

How to tackle congestion in acute heart failure

Pieter Martens  1   2 , Wilfried Mullens  1   3
Affiliations
Review

How to tackle congestion in acute heart failure

Pieter Martens et al. Korean J Intern Med. 2018 May.

Abstract

Acute heart failure is a common complication of chronic heart failure and is associated with a high risk for subsequent mortality and morbidity. In 90% of case acute heart failure is the resultant of congestion, a manifestation of fluid build-up due to increased filling pressures. As residual congestion at discharge following an acute heart failure episodes is one of the strongest predictors of poor outcome, the goal of therapy should be to resolve congestion completely. Important to comprehend is that increased cardiovascular filling pressures are not solely the resultant of intravascular volume excess but can also be induced by a decreased venous capacitance. This review article focusses on the pathophysiology, diagnoses, and treatment of congestion in acute heart failure. A clear distinction is made between states of volume overload (intravascular volume excess) or volume redistribution (decreased venous capacitance) contributing to congestion in acute heart failure.

Keywords: Congestion; Heart failure.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Relationship between intravascular volume and filling pressures in acute heart failure.
Figure 2.
Figure 2.
Targets for combinational diuretic therapy in volume overload. QD, once a day; HCTZ, hydrochlorothiazide; eGFR, estimated glomerular filtration rate; BUN, blood urea nitrogen; SGLT-2, sodium-glucose-linked transporter 2; MRA, mineralocorticoid receptor antagonist; HF, heart failure.
See this image and copyright information in PMC

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