Comments on ESC/ CSC Guidelines
Acute heart failure

Overview

Acute heart failure (AHF) refers to a rapid onset or worsening of symptoms and/or signs of heart failure (HF). It may present as a first occurrence (de novo) or, more frequently, as a consequence of acute decompensation of chronic HF, and may be caused by a primary cardiac dysfunction or precipitated by extrinsic factors. Clinical classification can be based on bedside physical examination in order to detect the presence of clinical symptoms/signs of congestion (wet vs. dry) and/ or peripheral hypoperfusion (cold vs. warm). The identification of acute etiology includes excluding of CHAMP (acute coronary syndrome, hypertension emergency, arrhythmia, acute mechanical case, pulmonary embolism). Natriuretic peptides (NPs) have high sensitivity, and normal levels in patients with suspected AHF makes the diagnosis unlikely (thresholds: BNP < 100 pg/mL, NT-proBNP < 300 pg/mL, MR-proANP < 120 pg/mL). However, elevated levels of NPs do not automatically confirm the diagnosis of AHF, as they may also be associated with a wide variety of other cardiac and non-cardiac causes. The management algorithm for patients with AHF is based on the clinical profile: diuretics, vasodilators, inotropes or vasopressors. Oral disease-modifying HF therapy should be continued on admission with AHF, except in the presence of haemodynamic instability, hyperkalaemia or severely impaired renal function. In these cases, the daily dosage of oral therapy may be reduced or temporarily suspended until the patient is stabilised. The patients should be examined by their general practitioner within one week of discharge and by the hospital cardiology team within two weeks of discharge.

Keywords:
acute heart failure – clinical profile – natriuretic peptides