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Acute Heart Failure

Sudden deterioration in the pumping action of the heart, usually leading to accumulation of fluid in the lungs

  • More common over the age of 65
  • Slightly more common in males
  • Genetics and lifestyle as risk factors depend on the cause

Heart failure is the term used when the heart’s ability to pump efficiently is reduced. In acute heart failure, the condition develops suddenly, often due to a severe heart attack. In most cases, only the left side of the heart is affected. This side receives oxygen-rich blood directly from the lungs and pumps it to the rest of the body. If acute heart failure develops, a back-up of blood occurs in the blood vessels leading from the lungs to the heart. Back pressure then causes a build-up of fluid in the lungs, known as pulmonary oedema. If it is not treated immediately, it is life-threatening.

What are the causes?

Acute heart failure often develops in people with chronic heart failure if the weakened heart is put under strain. For example, a severe infection, such as pneumonia, may increase the workload on the heart and lead to acute heart failure. Other common causes of acute heart failure are severe myocardial infarction; valve problems, including infective endocarditis; and rhythm problems, such as complete heart block or tachycardia.

Right-sided acute heart failure is rare. It is usually due to a blood clot blocking the pulmonary artery, which leads from the lungs to the right side of the heart (see Pulmonary embolism).

What are the symptoms?

The symptoms of acute heart failure usually develop rapidly and include:

  • Severe shortness of breath.

  • Wheezing.

  • Cough with pink, frothy sputum.

  • Pale skin and sweating.

If acute heart failure is caused by a heart attack, you may have additional symptoms such as intense, prolonged chest pain and feelings of anxiety. If heart failure is caused by a pulmonary embolism, you may cough up blood and have sharp chest pain that is worse when inhaling. If acute heart failure is not treated, it can cause dangerously low blood pressure (see Shock), and the condition may then be fatal.

What might be done?

Acute heart failure is an emergency and needs immediate hospital treatment. You will be treated sitting up and may be given oxygen through a face mask. You may also be given several drugs intravenously, including diuretics, morphine (see Painkillers), and nitrates to make you more comfortable and to help remove fluid from the lungs. You are likely to have electrocardiography (see ECG) and echocardiography to help determine the cause of heart failure. A chest X-ray is usually done to assess the size and shape of your heart and confirm the presence of fluid in the lungs. You may also have coronary angiography to look for narrowing or blockages in the coronary arteries.

Longer-term treatments will focus on the underlying cause. For example, blockage of the coronary arteries may be treated with coronary angioplasty and stenting. If the cause cannot be fully treated and chronic heart failure develops, drugs such as ACE inhibitors and digitalis drugs may be given to help reduce recurrences of acute heart failure and slow deterioration in heart function. However, in spite of these treatments, the condition may be progressive and ultimately fatal.

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

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