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Comments on ESC/ CSC Guidelines
Acute heart failure


Authors: L. Špinarová
Authors‘ workplace: I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně
Published in: Kardiol Rev Int Med 2016, 18(4): 246-252

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


Sources

1. Ponikowski P, Voors AA, Anker D et al. 2016 ESC Guidelines for the dia­gnosis and treatment of acute and chronic heart failure The Task Force for the dia­g­­-nosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37(27): 2129– 2200. doi: 10.1093/eurheartj/ehw128.

2. Spinar J, Parenica J, Vítovec J et al. Baseline characteristics and hospital mortality in the Acute Heart Failure Databáze (AHEAD) Main registry. Crit Care 2011; 15(6): R291. doi: 10.1186/cc10584.

Labels
Paediatric cardiology Internal medicine Cardiac surgery Cardiology
Topics Journals
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