Acute heart failure: What you need to know- Ian Franks

Acute heart failure is an illness that hits suddenly and without any earlier symptoms.

Indeed, the medical definition of acute, according to MediLexicon, is "a health effect, usually of rapid onset, brief, not prolonged; sometimes loosely used to mean severe."

This article looks at the causes, symptoms, and other facts about acute heart failure to help people understand this condition better.

Types of heart failure

Acute heart failure is heart failure that occurs suddenly and sometimes without warning.

Heart failure is the inability of the heart to pump enough blood to serve the body's needs. It can be acute or chronic. Chronic heart failure develops slowly, while acute occurs suddenly.

The heart is a complex organ. Any failure can take place on either the left or right side or both.

The heart has four chambers, which work in a rhythm to pump blood around the body. If these chambers stiffen, they may not fill sufficiently. If the heart, which is a muscle, is too weak, its chambers can stretch and fail to work properly.

Left-side heart failure is the most common type of heart failure, with symptoms that include shortness of breath.

This type can be divided into systolic and diastolic heart failure:

• Systolic affects the left ventricle, stopping it from pumping properly. It is associated with acute heart failure.
• Diastolic heart failure is caused by a blood-filling problem in the left ventricle.

Right-side heart failure can happen by itself, but it often occurs alongside left-side heart failure. This is because failure of the left chamber causes pressure on the right side, leading to damage.

Causes

There is no one cause of acute heart failure. So, what can lead someone who appears healthy to have this medical condition?

Acute heart failure can be brought about by one of the following causes:

• allergic reaction
• a blood clot in a lung
• a complication of cardiopulmonary bypass surgery
• heart attack, or myocardial infarction
• infection
• severely irregular heartbeat
• virus that damages the heart

Risk factors

There are several risk factors that, alone or together, increase the likelihood of heart failure. One risk factor can be enough to trigger heart failure.

Risk factors include:

• coronary artery disease
• diabetes
• diabetes drugs and some other medications
• heart attack
• heart defects
• high blood pressure
• irregular heartbeat
• kidney problems
• sleep apnea and other problems with breathing while asleep
• overuse of alcohol and some recreational drugs
• viral infection

Symptoms

Symptoms of acute heart failure may include swelling of the stomach, nausea, and coughing.

While many symptoms of acute heart failure are shared with other types of heart failure, they are often more obvious.

For example, sudden swelling of stomach and legs may occur, and fluid retention, causing rapid weight gain. Nausea or loss of appetite may also be experienced.

Other symptoms of acute heart failure might include:

• coughing and wheezing
• decreased ability to concentrate
• tiredness
• irregular or fast heartbeat
• shortness of breath
• weakness

Diagnosis

To reach a diagnosis, a doctor will carry out a physical examination and look at a person's medical history.

They will use a stethoscope to listen to the heart to check for abnormal rhythms, and to the lungs to check for congestion.

The doctor may check the abdomen, legs, and even veins in the neck for fluid retention. Finally, they may order additional tests, such as:

• angiogram
• chest X-ray
• CT scan or MRI scan
• blood tests
• echocardiogram
• electrocardiogram (ECG)
• stress test

Treatment

Doctors have a choice of how they treat someone with acute heart failure. Treatments include medication, surgery, and medical devices. A doctor might also advise changes to a person's lifestyle.

Medications

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

• widen blood vessels, lower blood pressure, and increase blood flow
• reduce blood pressure and slow heart rate, to normalize heart rhythms
• strengthen contractions, making the heart beat more slowly
• prevent water retention
• lower cholesterol
• thin blood to decrease the risk of clots forming and a stroke occurring

Hospitalization, surgery, and medical devices

Hospitalisation is likely for acute heart failure and there are many different types of treatment available.

Hospital care is an important aspect of treatment for acute heart failure, as many people will be hospitalized for this condition.

Types of heart surgery and medical devices that can be used to treat acute heart failure include:

• Cardiac resynchronization therapy, or a biventricular pacemaker: This is a device that uses electrical impulses to help the heart's ventricles pump more efficiently.
• Coronary bypass: A blood vessel is taken from another part of the body to work as a new route for blood to bypass a clogged artery.
• Heart pumps: Mechanical devices to keep people alive while they await a heart transplant, or to help people who cannot have a transplant.
• Heart transplant: Surgery for heart conditions where no other treatment will do. The wait for a donor's heart may be lengthy.
• Replacement or repair of heart valve: Treatment for a faulty heart valve.
• Implantable cardioverter defibrillators (ICDs): ICDs are put under the skin to monitor the heart's rhythm. If the rhythm changes dangerously, the ICD will shock it back to a normal rhythm.
• Oxygen: Quite often needed by patients in hospital. Some may require supplemental oxygen once they go home.

Lifestyle changes

The following are changes people can make to reduce their risk of heart failure:

• Checking body weight daily. A gain might indicate fluid retention.
• Eating less salt. Salt encourages water retention.
• Losing weight if overweight or obese.
• Limiting fluids, especially alcohol. Many heart drugs do not mix with alcohol.
• Limiting how much cholesterol and fat is consumed.
• Reducing stress by balancing exercise, meditation, and rest.
• Stopping smoking, which increases heart rate, decreases blood oxygen levels and elevates blood pressure. Smokers are not considered for heart transplants.
• Taking more exercise to strengthen the heart.
• Lifestyle changes should be made after discussion with a doctor.

Outlook

The outlook for people with acute heart failure depends on their overall health, along with the cause and severity of their condition.

It is possible and probable that a person can live well for years while taking heart medications.

However, the outlook for a person could be less certain if their heart failure leads to kidney or liver damage or other serious problems, such as a blood clot.