Acute Heart Failure

What is acute heart failure?

Acute heart failure describes a heart that can’t deliver enough oxygen-rich blood to your body. This happens because of a sudden, rapid decline in heart functioning and the amount of blood your heart can pump to the rest of your body. Acute heart failure is a life-threatening condition.

Heart disease and certain medical conditions can make your heart work harder than usual.

This extra effort leads to physical changes that can include:

• Enlarged heart.
• Decreased blood flow.
• Narrow blood vessels.
• Rapid or irregular heartbeat (arrhythmia).
• Stiff heart muscles.

The changes are small at first. They start long before you experience acute heart failure symptoms. Over time, the changes get worse, making your heart work harder than it should. When your heart is no longer able to keep up, acute heart failure occurs.

Acute heart failure is one of the most common reasons for a hospital stay for people older than 65. While providers see many cases of acute heart failure, each one is different. Your situation (and outcome) likely won’t be the same as that of someone else.

Types of acute heart failure

Acute heart failure can happen even if you don’t have a previous heart issue. Types of acute heart failure include:

• Acute decompensated heart failure (ADHF). You can get this type if you have a heart condition like coronary artery disease.
• De novo acute heart failure. You can get this type if you have no history of heart disease. You may have an ongoing health condition like diabetes that damages your heart.

What are the symptoms of acute decompensated heart failure?

One of the most common acute heart failure symptoms is shortness of breath (dyspnea). You may experience:

• Heavy breathing.
• A sensation like suffocating.
• Struggling to breathe while lying down.
• Tight chest.

Other acute heart failure symptoms may include:

• Abnormal heart rhythm (arrhythmia).
• Chest pain.
• Cough.
• Fluid retention (edema) in your arms or legs.
• Loss of consciousness.

If you notice any of these symptoms, seek emergency medical care as quickly as possible. The sooner you receive treatment, the better your chances of recovery.

What causes acute congestive heart failure?

Causes of acute heart failure include health issues that strain your heart, like:

• Heart rhythm problems (arrhythmia).
• Coronary artery disease.
• Heart valve disease.
• Cardiomyopathy.
• Advanced kidney disease.
• Alcohol use disorder.
• Blood clot in your lung (pulmonary embolism).
• Diabetes.
• High blood pressure (hypertension).
• Overactive thyroid (hyperthyroidism).
• Sleep apnea.
• Stroke.
• Viral infections (like rheumatic heart disease) that affect your heart.

What are the risk factors for acute decompensated heart failure?

While you may have a condition that can cause acute heart failure, certain behaviors may trigger it. These include:

• Not taking prescribed medicines.
• Not limiting salt or fluids.
• Using alcohol, substances or recreational drugs.
• Taking NSAIDs (nonsteroidal anti-inflammatory drugs).

What are the complications of acute decompensated heart failure?

Acute heart failure can lead to organ dysfunction when your organs don’t get enough blood and oxygen. Cardiogenic shock is another complication of acute heart failure. Both of these are life-threatening.

How is acute congestive heart failure diagnosed?

Healthcare providers perform a rapid assessment that includes:

• Your health history, including your personal or family history of heart disease. They’ll want to know about other health conditions, whether you use tobacco products and any medications you take.
• A physical exam to learn more about your symptoms and how severe they are. This includes listening to your heart and checking for signs of fluid retention.

What tests will be done to diagnose acute heart failure?

Healthcare providers use a variety of tests to assess your symptoms, like:

• Electrocardiogram (EKG) to record your heart’s electrical activity.
• Chest X-ray to check for fluid buildup in your heart or lungs.
• Echocardiogram to show heart movement and blood flow.
• Thoracic (chest) ultrasound to show edema.
• Angiography or heart catheterization to examine your heart’s blood vessels.
• BNP (biomarker) blood test to check for hormones that occur when pressures change inside your heart.
• Basic metabolic panel blood test, which shows signs of kidney or thyroid issues.

How is acute congestive heart failure treated?

Emergency treatment for acute heart failure restores blood flow and oxygen levels. Care often includes:

• Oxygen therapy, which delivers extra oxygen you breathe in through a mask.
• Vasodilators, which are medications that open narrowed blood vessels.
• Water pills (diuretics), which are medicines that help your body get rid of excess fluid.

Your provider will also treat the condition that caused acute heart failure.

Acute heart failure isn’t curable, but it’s treatable. After you leave the hospital, you may need medications, like beta-blockers or water pills, to maximize heart health. You may need other treatments to prevent future episodes of acute heart failure.

These treatments may include surgery to:

• Place a stent or create a bypass route for blood flow.
• Repair or replace worn-out heart valves (heart valve surgery).
• Implant a pacemaker or implantable cardioverter defibrillator (ICD) to help you maintain a regular heartbeat and help treat dangerous heart rhythms.
• Give your heart extra help with a ventricular assist device until you can have a transplant.
• Replace your heart with a healthy one from a donor (heart transplant).

How can I lower my risk of acute heart failure?

Living a heart-healthy lifestyle can lower your risk of acute congestive heart failure.

This includes:

• Maintaining a weight that’s healthy for you by eating meals that include plenty of fruits and vegetables.
• Quitting tobacco products if you use them and avoiding secondhand smoke.
• Getting regular physical activity and restful sleep.
• Managing stress with deep breathing or relaxation techniques.
• Following care instructions for chronic conditions like sleep apnea or diabetes.

What can I expect if I have acute heart failure?

If you’re in the hospital, you may be there for several days or even beyond one week. Once you’ve had acute heart failure, you’re at a higher risk of having it again. You have a higher risk of acute heart failure becoming fatal if your kidneys aren’t working well. Other signs of advanced heart failure include shortness of breath that won’t go away, weight loss, or two or more hospital stays in one year.

How long can someone live with heart failure?

Generally, the outlook for acute heart failure is poor. About 10% to 30% of people with acute heart failure return to a hospital within 90 days and don’t survive a year.

But the prognosis for heart failure varies widely and depends on the underlying cause and whether a provider can treat it.

Your outlook depends on a variety of factors, including:

• Heart failure cause and severity.
• How quickly you receive care.
• Your overall health and response to treatment.
• Commitment to heart-healthy living.

How do I manage acute heart failure?

Life after acute heart failure often includes changes, like getting more physical activity. You may also need to avoid certain foods and limit salt and fat intake.

It’s important to pay careful attention to your body. This can help you detect the early signs of heart failure that come back after treatment. Your daily routine may include weighing yourself to see if you’re retaining fluid. Ongoing medical care can help you feel your best.

When should I see my healthcare provider?

After leaving the hospital, you’ll likely have a follow-up appointment in a week or two. Contact your healthcare provider if your symptoms get worse again after you go home. Seek emergency care if you’re struggling to breathe or have the other symptoms of acute heart failure.

What questions should I ask my healthcare provider?

Questions to consider asking your provider include:

• Can you tell me what caused me to have acute heart failure?
• Can you treat the cause or tell me how to prevent it in the future?
• What’s my prognosis (outlook) based on my situation?
• Can you refer me to a dietitian for help choosing heart-healthy foods?