Acute Heart Failure

Written by Teresa Bergen
Medically Reviewed by George Krucik, MD

Acute Heart Failure

Heart failure occurs when your heart cannot pump enough blood to meet your body’s demand. This can be chronic, meaning it happens slowly over time; or it can be acute, meaning it happens suddenly. Approximately 15 million new cases of heart failure happen every year worldwide. In the U.S., heart failure is the number one cause of people over 65 being admitted to the hospital. (Klabunde, 2011)

Types of Heart Failure

Heart failure can be caused by many different problems. The failure could begin on the left or right side of your heart, or both sides may fail at the same time. The chambers where your blood is pumped are called ventricles. These may stiffen so that they no longer fill properly. If your heart muscle is too weak, the ventricles can stretch out and fail to work efficiently.

These are a few different types of heart failure:

Left-sided heart failure: This is the most common type of heart failure. You may become short of breath, due to backed-up fluid in your lungs. There are two types of left-sided heart failure:

  • systolic heart failure: This pumping problem prevents the left ventricle from proper pumping and is most often associated with acute heart failure.
  • diastolic heart failure: This is caused by a blood-filling problem in the left ventricle.

Right-sided heart failure: This usually happens simultaneously with left-sided heart failure. When the left ventricle fails it results in increased pressure, and subsequent damage, to the right side of the heart. The right side of the heart cannot pump efficiently, causing fluid to accumulate in the veins, which may cause your legs and feet to swell.

Causes of Heart Failure

Many conditions weaken or damage the heart over time. This can lead to chronic heart failure. Some result from internal factors, such as disease or a birth defect. Others come from external factors, such as a poor diet and lack of exercise. Conditions leading to chronic heart failure include high blood pressure, diabetes, faulty heart valves, coronary artery disease, inherited heart defects, and a damaged or inflamed heart. With all these conditions, the heart adapts over time until it just cannot adapt anymore. Then it fails.

Heart failure and cardiovascular disease in general can also be genetic. If either one of your parents has experienced heart failure, you are at an increased risk — particularly if they experienced symptoms before age 50, indicating their heart failure was due to genetics rather than only lifestyle choices (poor diet and inactivity leading to high blood pressure, clogged arteries, etc.).

Sometimes one of these chronic conditions leads to an acute event. Other times, the person seems healthy, but then there is a sudden heart event that results in failure. Causes of acute failure include:

  • infections
  • allergic reactions
  • a blood clot in your lungs
  • viruses that damage the heart
  • cardiopulmonary bypass surgery
  • severely irregular heartbeats
  • heart attack

While one risk factor could be enough to trigger heart failure, a combination of risk factors can increase the possibility of heart failure. Risk factors include:

  • coronary artery disease, or narrowing of the arteries
  • high blood pressure
  • diabetes
  • heart attack
  • irregular heartbeat
  • some medications, especially diabetes drugs
  • sleep apnea, problems breathing while sleeping
  • heart defects
  • overuse of alcohol or other toxic drugs
  • viral infection
  • kidney problems

Symptoms of Acute Heart Failure

Chronic and severe heart failure share many symptoms. But with acute heart failure, these symptoms may be much more pronounced. Your legs and abdomen may suddenly swell, and you could rapidly gain weight from retaining fluid. You might be nauseous or lose your appetite. Other symptoms of both acute and chronic heart failure include:

  • shortness of breath (the most common symptom, experienced by almost all people suffering acute heart failure)
  • weakness
  • fatigue
  • irregular or fast heartbeat
  • coughing and wheezing
  • spitting up pink phlegm
  • decreased ability to concentrate

If you are having a heart attack, you may also have chest pain.

Elderly people may have several health conditions, often making it difficult to isolate symptoms of a heart problem from those caused by other conditions. If you have some of these symptoms and are unsure what is going on, seek emergency medical treatment. According to ScienceDaily, people hospitalized with acute heart failure had an average delay time of 13.3 hours between noticing symptoms and getting treatment. (ScienceDaily, 2009) The faster that symptoms are identified and medical help is sought, the better the outlook.

Diagnosis of Acute Heart Failure

You doctor will start with a physical exam and medical history. He or she will listen to your heart and lungs with a stethoscope. This will detect congestion or abnormal heart rhythms. Your doctor might check for fluid build-up in your abdomen, legs, and the veins in your neck.

In addition, your doctor might order some combination of the following tests:

Chest X-ray

This imaging test allows your doctor to better examine your heart and lungs.

Blood tests

The lab might check your thyroid and kidney function through a blood test. Your blood may also be analyzed for levels of certain substances, such as electrolytes and proteins. Abnormal levels of these substances may indicate a strain on the kidneys or liver, which often results from heart failure.

Stress test

This type of test measures your heart activity during physical exercise. Your doctor might want you to walk on a treadmill or ride a stationary bike to test how your heart responds to exertion. A stress test may also be done by taking a drug that speeds your heart up as if you are exercising. A nuclear stress test monitors the heart both during physical activity and while you’re at rest. This test also uses injectable dye to evaluate blood flow within the heart.

Electrocardiogram

For an electrocardiogram, your doctor attaches electrodes to your skin and then records your heart’s electrical activity.

Echocardiogram

This test uses sound waves to form an image of your heart. Your doctor will be able to see how much blood your heart is pumping.

Angiogram

Your doctor inserts a catheter, or thin tube, into your groin or arm. This is guided through your blood vessels and eventually into your coronary arteries. After injecting dye through the catheter, your doctor can see an image of your arteries.

CT scan or MRI

Both cardiac computed tomography (CT) scans and magnetic resonance imaging (MRI) help diagnose heart problems by showing your doctor images of your organs. Both involve lying inside machines while your picture is taken via X-ray.

If you are diagnosed with heart failure, your doctor may categorize the severity of your condition on one of several scales. According to the Mayo Clinic, the New York Heart Association scaleranges from one to four, with one being least severe and four being the worst. The American College of Cardiology scale uses the letters A to D.; a score of ‘A’ signifies that a person has certain heart failure risk factors, while ‘D’ indicates end-stage heart failure. (Mayo Clinic, 2011)

Treatment of Acute Heart Failure

Medication, surgery, medical devices, and lifestyle changes are the main ways to treat heart failure.

Medications

In many cases, a combination of at least two medications is necessary to manage heart trouble. Some of these medications include:

  • angiotensin-converting enzyme (ACE) inhibitors: This type of drug widens your blood vessels, which lowers blood pressure and increases blood flow. This makes your heart’s job easier.
  • angiotensin II receptor blockers: These drugs are similar to ACE inhibitors, but some people have fewer side effects from this type of drug.
  • beta blockers: These drugsreduce blood pressure and slow your heart rate. They help to normalize the rhythms of your heart.
  • digitalis: This drugstrengthens the contractions of your heart and makes it beat more slowly.
  • diuretics: Also known as water pills, these medications prevent fluid from accumulating in your body.
  • aldosterone antagonists: This is a kind of diuretic that may lengthen the lives of people with severe heart failure.

You might also need medicines to lower your cholesterol or treat chest pain. Your doctor may prescribe a blood thinner to avoid blood clots.

Hospitalization, Surgery, and Medical Devices

People with acute heart failure are hospitalized. Often they need to be put on oxygen while in the hospital, and may also require supplemental oxygen in the long term.

Surgery is also widely used to treat heart failure. Some common types of heart surgery include:

  • heart valve replacement or repair: If your heart fails because of a problematic heart valve, your doctor may want that valve repaired or replaced. There are many ways to do this, either involving repairing your own valve or getting an artificial valve.
  • coronary bypass surgery: In this surgery, the surgeon removes a blood vessel from another part of your body. This blood vessel is fashioned into a new pathway to work around a clogged artery.
  • implantable cardioverter-defibrillators (ICDs): ICDs are implanted under your skin, like a pacemaker. Wires tunnel through your veins to monitor your heart rhythm. If the rhythm deviates dangerously, the ICD tries to shock it back to normal.
  • heart pumps: These mechanical devices can be used to keep people alive while they wait for a donor heart. Sometimes they are used instead of a transplant. This device can extend the lives of people who are not eligible for transplant surgery.
  • cardiac resynchronization therapy: Also called a biventricular pacemaker, this device helps the ventricles pump more efficiently by sending electrical impulses.
  • heart transplant: If the condition is so severe that other alternatives will not work, some people get heart transplants. However, the demand for donor hearts is far greater than the supply.

Lifestyle Changes

Changing certain behaviors can also reduce risk factors for, or symptoms of, heart failure.

  • If you smoke, ask your doctor for help quitting. Smoking increases your heartbeat, decreases the amount of oxygen in your blood, and elevates your blood pressure. If you smoke, you will not be considered for a heart transplant.
  • Heart patients should weigh themselves daily. If you gain more than three pounds in a day, it might mean you are retaining fluids and need to make changes to your treatment plan.
  • If you are overweight, work with a dietitian to bring your weight down. Even a few pounds can help.
  • Eat less salt. Sodium increases water retention, which demands more work from the heart.
  • Limit the amount of cholesterol and fat in your diet. High levels of fat increase your risk for coronary artery disease, a leading cause of heart failure.
  • Limit fluids, especially alcohol. Many heart medications have negative interactions with alcohol.
  • Talk to your doctor about exercise. Aerobic activity strengthens the heart. You might be eligible for a cardiac rehab program.
  • Decrease your stress level. Exercise, meditation, and resting from time to time are good ways to manage stress.

Preventing Acute Heart Failure

Though some risk factors for heart failure, such as genetics or chronic illness, cannot be avoided, the key to preventing heart failure is reducing the risk factors you can control. Certain lifestyle changes can help reduce or eliminate conditions that lead to heart failure, such as high blood pressure or high cholesterol. These include:

  • maintaining a healthy weight
  • regular exercise – talk to your doctor about the type of exercise that is best for you
  • eating a balanced, healthy diet
  • quitting smoking
  • finding ways to manage stress
  • managing pre-existing conditions, especially heart conditions. Have regular checkups and take medications faithfully.

Long-Term Outlook

Your outlook depends on your overall health, the cause, and degree of your heart failure. Many people feel good for years while taking heart medications or living with implanted medical devices.

However, your outlook could be further complicated if your heart failure leads to kidney or liver damage, or problems with your heart valves. Blood clots are also common after heart failure.

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