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Acute Heart Failure All You Need To Know – Heart Failure

Heart failure most people think is solely a chronic condition but can be sharp, as we see in acute heart failure. It is a condition where the heart does not pump blood effectively because of structural or functional cardiac abnormalities.

This condition afflicts over 5 million people in the United States, and there are over half a million new cases every year. It affects mostly people over 65 years old.

Within this article, you will find answers to some of the most common questions like what it is; is it curable, how long you can live, and many others. Before reaching that point, there will be brief explanations about basic concepts to understand this disease.

By reading this article, you will obtain critical insights about Heart Failure, its causes, its symptoms, and its diagnosis. Please continue reading to get pearls on this specific topic by the hands of a Doctor.

How does the heart works?

The heart is one of the essential organs in the body. It is a muscle that works with electricity to contract itself to pump blood through the body. However, this is not so simple; the heart has millions of special cells that receive the name myocardiocytes.

These special cells have a unique attribute that differences them from the others. While other cells in the body have specific delimitations, and each one is separated from the other, they are all united.

The myocardiocytes do not have a barrier that separates them from one to another. This allows the electric impulse to travel freely and in a more efficient way through the muscle. Finally, it will cause a heartbeat.

The heart consists of four spaces, two atriums, and two ventricles. Each one of them will have a sort of gate; these are the valves. Each of them will have a specific name, and they will prevent the blood from moving freely within the heart.

These valves block the way backward or afterward and keep the blood within a space for a brief moment. They open with pressure changes within the heart because of the heart dynamic.

Heart Anatomy
Source

Mechanism

To adequately explain how does the heart works, there are some essential terms you must know.

Diastole and systole are the two phases that make the heartbeat. The diastole is the phase of the cardiac cycle in which the heart muscles relax, and the blood fills the heart’s ventricles.

The systole is the phase in which the heart contracts itself and produces the blood’s ejection to the body. Preload is the maximum amount of blood that there can be within a ventricle after the diastole. In other words, the amount of blood that the heart can pump.

The afterload is the pressure the left ventricle must overcome for the valve to open and let the blood out of the heart. Heart rate is the number of heartbeats a person has in one minute. Similarly, the cardiac output is a measure of the heart rate multiplied by the amount of blood that goes out of the heart in the systole or ejection.

Cardiac Cycle

The blood flow within the body has two systems: the lungs and the rest of the body. The heart also divides itself into two different parts: the right heart and the left heart.

Importantly, the right heart receives the unoxygenated blood (blood without oxygen) from the body through large veins, the inferior and superior vena cava. Then, the blood goes into the right atrium filling the cavity and raising the pressure within it. When the pressure is sufficient, the tricuspid valve will open, and the blood will fill the right ventricle.

Once the right ventricle receives blood, with a little help of the heart’s contraction, this will open the pulmonary valve. The blood will go into the pulmonary artery and will go directly into the lungs to receive oxygen.

The left heart receives directly from the lungs the oxygenated blood (blood with oxygen) through the pulmonary veins. Nonetheless, the blood vessels within the lungs have lower blood pressure than the Aorta. This means that the right heart is a significantly lower pressure system than the heart’s left side.

Now the process is very similar to the right heart. The blood enters freely to the left atrium. It has to overcome the pressure of the mitral valve to fill the left ventricle. Identically to the right side, when the left ventricle is filled, the contraction will help overcome the pressure of the aortic valve to let the blood out. 

The left heart has to overcome a higher pressure than the right side as the Aorta has more pressure than blood vessels within the lung. The left heart is a high-pressure circuit as the cardiac muscle applies more strength to the contraction, and it has a higher pressure to beat.

What is acute heart failure?

For defining acute heart failure, it is essential to determine first heart failure. Heart failure (HF) or congestive heart failure is a chronic and progressive condition induced by structural or functional cardiac abnormalities.

So basically, the heart muscle does not pump blood as well as it should. It can be with a reduced ejection fraction (systolic heart failure) or preserved ejection fraction (diastolic heart failure). This means that the amount of blood that leaves the heart can remain preserved or reduced, causing pressure abnormalities within the heart. 

Acute heart failure (AHF) syndrome is defined as a rapid onset of new or worsening heart failure signs and symptoms. Acute HF is often a potentially life-threatening condition that requires hospitalization and emergency treatment.

Most of AHF patients are heart failure patients with a previous history that present an acute decompensation. There is a sudden increase in intracardiac filling pressures and/or acute myocardial dysfunction (out of sudden impairment of the heart muscle) in patients who do not have a pre-existing heart condition.

This situation will ultimately lead to a decrease in peripheral perfusion and pulmonary congestion or pulmonary oedema. That is to say that the blood will not get to all the organs and tissues distant to the heart as it should. Besides, the blood that stagnates in the lung can cause a leak of liquid that genuinely affects the patient.

Furthermore, this happens because the pressure within the heart is too high due to fluid overload. The fluid will go to where there is lower pressure. Hence, it is going back to the lungs, causing the blood to stay there, filling them with fluids.

The most common cause for this to happen in these patients is coronary artery disease that causes an acute myocardial infarction (or heart attack). This leads to a decrease in the contractility of the heart, causing fluid overload. These patients can later become HF patients due to the heart’s damage because of acute coronary syndrome.

Is acute heart failure a heart attack?

No, it is not a heart attack exactly, but it can result from a heart attack. The acute heart failure can also be the sudden worsening of a pre-existing condition like chronic HF.

Heart failure is a progressive condition that affects the heart muscle. The myocardial infarction can accelerate this process as well and lead to acute heart failure.

Let me put this in simpler words. The heart attack or myocardial infarction will prompt the heart muscle not to receive enough oxygen causing a malfunction.

If the heart does not receive enough oxygenated blood, it will cause ischemia of the muscle. Then again, when this happens, it means that many cells can die, ultimately leading to a scar within the heart muscle. The damaged cells will regenerate; however, they will not have the ability to contract effectively as the original ones.

The scar will have a composition of collagen instead of muscle cells, so the contractility (or the capacity to pump) seems affected. Although the scarring process does not happen immediately, the myocardial infarction will also cause acute heart failure.

This situation exists because when the muscle does not receive the blood, it will stop working mostly because of systolic dysfunction or inability to pump blood. This will cause fluid overload within the heart. The pressure will accumulate. While trying to look for the relief, it will go to the lungs causing pulmonary edema.

What are the four stages of heart failure?

For the staging of heart disease, cardiologists have two different classifications, the ACC/AHA (American College of Cardiology / American Heart Association) and the NYHA (New York Heart Association) classification.

Both of them have four stages; however, the NYHA classification considers the symptoms of the patient. The ACC/AHA classification is the most common, and it emphasizes the objective findings. For didactic purposes, we will only explain the ACC/AHA Classification.

  • Stage A: This stage is for patients that are at risk for developing heart failure. Nonetheless, these patients have not yet developed structural heart changes—for example, patients with high blood pressure, diabetes, or coronary disease without infarction.
  • Stage B: These are patients who already have structural heart disease but have not yet developed heart failure symptoms. Among the structural changes are the reduced ejection fraction and chamber enlargement.
  • Stage C: This stage is for patients with symptoms and clinical heart failure. Once a patient reaches this stage, it cannot go back to previous steps.
  • Stage D: This stage is for patients with refractory heart failure that requires advanced intervention like pacemakers or transplantation. 

What is the difference between acute heart failure and chronic heart failure?

As the name says, the difference can be pretty straightforward, one of them is a sudden event, and the other is a progressive condition.

Acute heart failure is when a patient develops suddenly new symptoms or the worsening of previously existing symptoms. On the other hand, chronic heart failure is a progressive condition that affects the heart muscle causing it not to pump blood in an effective way.

Moreover, acute heart failure can happen after a sudden event like a heart attack. And, it is essential to note that chronic heart failure comes after the patient develops acute heart failure for the first time.

Chronic heart failure can also happen when the heart overworks. The latter term occurs when conditions like high blood pressure cause the heart to pump harder than usual. This leads to progressive changes in the left heart, enlarging the muscle, and raising blood and oxygen needs.

Chronic heart failure can happen without previous heart infarction. The heart will go through a process of changes that will ultimately lead to pressure changes within it. Of course, this can lead to life-threatening conditions as well.

Finally, it is important to have in mind that despite both of them having different times of onset, both lead to the same changes in the heart.  

What causes acute congestive heart failure?

Acute congestive heart failure can happen in various ways. It can result from the combination of an underlying but newly diagnosed cardiac dysfunction and precipitating factors or the onset of a new cardiac dysfunction (de novo HF). Or the combination of an underlying chronic cardiac dysfunction and one or more precipitating factors (acutely decompensated HF (ADHF), that is, decompensation of chronic HF).

Precipitating factors may directly affect left ventricular (LV) or right ventricular (RV) function [for example, myocardial ischaemia (heart muscle cells’ lack of blood supply) and arrhythmias (electrical heart abnormalities)]. These other factors may also contribute to the development of congestion (for example, infection, hypertension, and non-compliance with treatment recommendations).

Heart failure is common in patients with high blood pressure as the heart has to make an extra effort to pump the blood. This will induce stress in the heart muscle, and the heart cells will become larger, die, and then regenerate themselves.

This situation will eventually lead to a change of the heart wall and will reduce the cardiac output. This means that the heart becomes larger in size and loses contractility or capacity to pump. The contractility loss causes the heart to retain more blood than it should and will eventually cause congestion. The heart muscle will also require more oxygen than average, making it very likely to develop an ischemic disease or a state where there is no sufficient oxygen offer for the high demands.

The decrease in the cardiac output or blood that is coming out of the heart will activate receptors within the blood vessels that will send signals to the kidney. The kidney (or renal function) will be activated and release hormones that will increase heart rate and contractility of the heart. Also, the preload and the afterload will be increased due to these hormones. This leads to a vicious cycle that will ultimately affect heart functionality and cause negative remodeling and heart failure symptoms.

What are acute heart failure symptoms?

Acute heart failure symptoms are very similar to the symptoms of chronic heart failure. Nonetheless, these symptoms may be more severe or pronounced with acute heart failure, though.

The symptoms are the following:

  • Shortness of breath: It is the most common symptom of acute heart failure. This can happen while making minimum efforts or while lying in bed.
  • Swelling: Legs and abdomen may suddenly swell, and patients can rapidly gain weight from retaining fluid. 
  • Nausea
  • Loss of appetite
  • Weakness
  • Fatigue to minimum efforts or while resting
  • Abnormal heart rhythms or a fast heartbeat
  • A decrease in the ability to concentrate
  • Spitting up pink phlegm 
  • Coughing and wheezing
  • Veins in the neck become bigger
  • The coolness in hand and feet due to a decrease in the cardiac output
  • Fainting
  • Blue/colored lips, skin or tongue, also called central cyanosis
  • Congestion in the kidneys may lead to renal dysfunction. This causes less urine throughout the day and frequent urination during the night. 

What is a sign of worsening heart failure in older adults?

Older adults are a population at risk of developing severe symptoms of heart failure. These patients are very likely to develop acute decompensation of heart failure. Most of the elderly adults have an underlying disease that may be worse over time.

The following signs and symptoms are something to be very aware of in elderly patients with heart failure:

  • Sudden weight gain (2–3 pounds in one day or five or more pounds in one week)
  • Extra swelling in the feet or ankles
  • Swelling or pain in the abdomen
  • Shortness of breath not related to exercise
  • Discomfort or trouble breathing when lying flat
  • Waking up in the middle of the night because of shortness of breath
  • Coughing or wheezing
  • Increased fatigue
  • Mental Confusion
  • Loss of appetite

How is heart failure diagnosed?

To make a diagnosis of heart failure, the doctor will initially assess the disease by making a physical examination and taking a careful look at medical history.

The doctor will also ask for risk factors like smoking, diabetes, coronary artery disease, and high blood pressure. Using a stethoscope, the doctor may hear abnormal heart sounds that suggest heart failure or congestion signs.

After the physical examination, the doctor may ask for some of these tests:

  • Blood test: The physician takes a blood sample to look for signs of diseases that may affect the heart. This test includes examining hemoglobin, red blood cell count, and serum creatinine, among others. If the diagnosis is not sure after other tests, the doctor may ask for natriuretic peptides.
  • Chest X-Ray: X-ray images help the doctor to see the condition of the lungs and the heart.
  • Electrocardiogram (ECG): This test records the electrical activity of the heart. It enables the doctor to see abnormal heart rhythms and damage to the heart.
  • Echocardiogram: This test helps the doctors see the heart’s size and shape along with any abnormalities. It measures the ejection fraction of the heart as well.
  • Stress Test: This test measures how the heart responds to exercise and physical activity. The patient may need to walk on a treadmill while attached to an ECG.
  • Cardiac Computerized Tomography scan: This test enables the doctor to see more specific images of your lungs and heart.
  • Coronary Angiogram: This test uses a catheter through a blood vessel and injects a dye-making the arteries visible in X-Ray, helping doctors spot blockages in the heart arteries.
  • Myocardial Biopsy: By taking a small piece of tissue, the doctor may diagnose specific types of heart muscle diseases that cause heart failure. 

Is acute heart failure curable?

Acute heart failure is the sudden onset or worsening of existing chronic heart failure. Towards this specific condition, there is no definitive cure. However, the doctor may indicate treatment for managing the symptoms and prevent the worsening of the disease.

It is essential to know that this condition is the worsening of previous symptoms. Besides, it is a manageable and preventable condition, but it has no definitive cure.

Nonetheless, HF patients who receive appropriate medical attention quickly may have a very good clinical outcome. The time in this condition plays a significant role, so people should be aware of warning symptoms.

Hospitalized patients will be in observation after managing the symptoms to see how they respond to the treatment. The treatment includes several drugs to compensate for fluid overload like intravenous diuretics. This is a potentially deadly condition, so it must be taken seriously and also takes into consideration the possible outcomes of the disease.

How is Heart Failure treated?

The treatment of heart failure is complex; doctors usually treat heart failure with a combination of medications. The medications your doctor prescribes may depend on the symptoms the patient has. It can also include surgery and medical devices in severe cases.

The treatment can be the following:

Medications

  • Angiotensin-converting enzyme (ACE) inhibitors: These drugs help people with systolic heart failure live longer and feel better. These drugs widen blood vessels to lower blood pressure, improve blood flow, and decrease the heart’s workload. 
  • Angiotensin II receptor blockers: These drugs have the same effects as ACE inhibitors; nonetheless, these may be an alternative for patients who cannot tolerate ACE inhibitors. 
  • Beta-blockers: These drugs reduce signs and symptoms of heart failure, improve heart function, and help the patient live longer. They reduce the heart rate and blood pressure, and they also limit or reverse some of the damage to the heart if the patient has systolic heart failure.
  • Diuretics: Diuretic therapy is widespread among patients with heart failure. These are drugs that help managing fluids within the body and make the patient urinate more frequently. Several types of diuretics, like loop diuretics or thiazide diuretics, improve the renal function, and help with fluid retention. 
  • Aldosterone Antagonists: These drugs are diuretics as well, but these are potassium-sparring diuretics. They have as well additional properties that may help patients with severe systolic heart failure live longer. However, these diuretics can raise potassium in blood to dangerous levels.
  • Inotropes: These are drugs for hospitalized patients with severe heart failure to improve heart pumping function.
  • Digoxin: This drug reduces the heart rate but increases the strength of the heart muscle contractions. This drug is more likely to be used in patients with a heart rhythm problem like atrial fibrillation.

Surgical Interventions

  • Coronary bypass surgery: It is a surgical procedure that helps the blood flow freely through the heart. It helps to unblock arteries that contribute to heart failure.
  • Heart valve repair or replacement: If a faulty valve is what causes heart failure, the doctor may recommend this procedure. This may help to eliminate backward blood flow. Through some tests, the doctors may recommend reparation or replacement by an artificial valve.
  • Implanted cardioverter-defibrillators: It is very similar to a pacemaker. If the heart begins to beat at a dangerous rhythm or stops, this machine tries to pace the heart or shock it back into a normal rhythm. This is very helpful in patients with atrial fibrillation and ventricular tachycardia.
  • Heart transplant: Some patients have such a severe heart failure that surgery or medications will not help. A heart transplant can improve the survival and quality of life of some people with severe heart failure. Nonetheless, these patients may wait a long time before a suitable donor heart is found. This procedure is not the right treatment for everyone. A group of doctors will determine if this is an option for the patient.

How long can you live with heart failure?

The average life expectancy of a patient with heart failure, according to statistics, is about 5.5 years. However, this is very variable, and it depends as well on the staging of the disease.

For those with advanced stages of the disease, life expectancy is about two years. About 90% of patients with severe heart failure die within the first year. For patients with mild heart failure, life expectancy is longer.

The recent advances in therapies and being in recurrent control with a doctor may improve life expectancy. 

About 50% of these patients will not live for five years, but the other 50% may live longer, and 10% of patients can even live for ten years. These numbers are not encouraging, but heart failure is a life-threatening condition. If not controlled, it may get more severe. It also depends on the age of the patient; elderly patients will have a shorter lifespan while younger patients may have a longer lifespan.

Asides from medications, making lifestyle changes may also help to increase the lifespan. Some of the lifestyle changes that doctors recommend are the following:

  • Diet: Patients with heart failure should take a low-sodium diet as sodium helps to increase fluid retention within the body.
  • Exercise: Aerobic exercise improves the overall ability of the heart to function, thereby, it gives better life quality, and it potentially may increase life expectancy
  • Fluid restriction: These patients should take care of the liquids they consume daily, precisely the quantity. Nonetheless, there are medications like diuretics to help with this specific issue.
  • Weight monitoring: Increase in body weight is the first sign of fluid retention. Patients with heart failure should check their weight daily to see if they retain liquids and act promptly by visiting a doctor.

Are you having symptoms of it?

This tool is a congestive heart failure symptoms checker. It gathers the most important symptoms, signs, and risk for heart failure. Therefore, it will tell anybody who uses it the likelihood of having or developing in the future this condition. It is free and would only take a few minutes to complete it.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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