Acute Heart Failure (AHF): Causes, Symptoms, and Treatment

Heart failure is when the heart is unable to pump an adequate supply of blood to meets the body’s needs. This can occur over time, which means it is a chronic condition. On the other hand, in some cases, heart failure can occur suddenly. When it does, it is known as acute heart failure.

Acute heart failure (AHF)—also known as acutely decompensated heart failure—requires emergency medical attention. It is most commonly seen in individuals over the age of 55 and can affect all areas of the heart.

Prevalence of Acute Heart Failure

Acute heart failure is common among African Americans, Native Americans, and Hispanics. Over one million patients a year are admitted to hospitals with the heart failure, and most patients are over the age of 65.

What Are the Causes and Risk Factors for Acute Heart Failure?

Because acute heart failure occurs suddenly and can even occur among those who seem healthy, there are a wide variety of causes that can trigger it. Some of those causes include an allergic reaction, a blood clot in the lung, a complication resulting from cardiopulmonary bypass surgery, heart attack, infection, a severely irregular heartbeat, or a virus that attacks the heart.

Risk factors include coronary artery disease, diabetes, diabetes drugs along with some other medications, heart attack, heart defects, high blood pressure, kidney problems, sleep apnea and other sleep-related breathing problems, overuse of alcohol and recreational drugs as well as viral infections.

Acute Heart Failure: Signs and Symptoms

The most common symptom of acute heart failure is shortness of breath. Much of acute heart failure’s symptoms are similar to that of a heart attack or heart failure. The main difference is that the symptoms are much more pronounced. You may experience sudden swelling of the abdomen and legs and rapid weight gain as a result of fluid retention. This weight gain can be seen as quickly as 24 hours up but may take a week to appear. You can also experience nausea and loss of appetite.

Other symptoms include fatigue, weakness, irregular or fast heartbeat, coughing or wheezing, spitting up ink phlegm, and a decreased ability to concentrate. If left untreated acute heart failure can result in a heart attack.

Because acute heart failure commonly occurs in seniors, it can be difficult to isolate symptoms, but if you do experience any of the above symptoms, you should seek medical attention right away.

Health Conditions That May Accompany Acute Heart Failure

For some patient’s, other conditions may accompany acute heart failure. These conditions include:

Atrial fibrillation:

Atrial fibrillation is characterized by a rapid and irregular heartbeat that occurs when the upper chambers—called the atria—quiver erratically. Atrial fibrillation is a treatable condition, yet as few as 30 percent with the condition receive the recommended treatment.

Acute coronary syndromes (ACS):

An umbrella term that refers to the sudden blockage of blood flow to the heart. Examples of ACS include unstable angina and heart attack.

Chronic obstructive pulmonary disease (COPD):

The name for a collection of lung conditions including chronic bronchitis, emphysema, and chronic obstructive airways disease. People with COPD have difficulties breathing because of the narrowing of their airways—suitably called airflow obstruction.

Renal insufficiency:

Refers to the poor function of the kidneys possibly caused by a reduction of blood flow caused by an artery disease.

How to Diagnose Acute Heart Failure

After reviewing your symptoms, your doctor will run several tests to confirm diagnosis of acute heart failure. For starters, they will listen to your lungs to hear any congestion or abnormalities in heart rhythms.

Other tests include chest x-rays, blood tests, stress tests, electrocardiograms, echocardiograms, angiogram, CT scans, and MRI scan.

Your doctor may also request laboratory tests to measure BNP/NT-proBNP, electrolytes, renal function markers, and troponin. Increased presence of BNP/NT-proBNP reveals elevated ventricular pressure and volume and can help diagnose acute heart failure. Although there are no “diagnostic levels” of BNP/NT-proBNP, there are three ranges that doctors pay attention to.

A BNP less than or equal to 100 pg/mL is strongly suggestive of non–heart failure etiology for the dyspnea, BNP 100 to 400 pg/mL is indeterminate, and BNP greater than 400 pg/mL is strongly supportive of AHF.

Measuring electrolytes is also an important diagnostic test, as they reflect a person’s clinical course prior to disease onset. Changes in electrolytes could reveal an underlying cardiovascular or renal problem that could contribute to acute heart failure.

Measuring renal function—kidney function—is important because poor renal function is associated with acute heart failure.

Lastly, higher troponin levels occur in 15 to 70 percent of patients. Higher levels are often seen in heart-related problems, so your doctor will need to distinguish the cause of the higher levels.

Acute Heart Failure Treatment

The moment symptoms present themselves, you should seek out emergency treatment. Once admitted to a hospital, the doctor’s goal is to stabilize you. You may be put on oxygen as a result.

Treatment is centered around managing symptoms and preventing long-term damage. Treatment can consist of medications, surgery, or medical devices.

Medications that your doctor may prescribe help combat heart-related problems. These medications include angiotensin-converting enzyme inhibitors (ACE), angiotensin II receptor blockers, beta-blockers, digoxin, diuretics, and aldosterone antagonists. Your doctor may also recommend cholesterol-lowering medications and blood thinners. Antibiotics may be prescribed if there is an infection present.

Surgery is another treatment option for acute heart failure. Common surgeries include heart valve replacement and coronary bypass surgery. In coronary bypass surgery, a device may be implanted to restore normal heart function. These devices include a biventricular pacemaker, implantable cardioverter-defibrillator, or heart pumps. In severe cases, your doctor may recommend a heart transplant. This is only considered if other treatment options are not effective.

Prevention and Lifestyle Changes for AHF

Lifestyle changes are important to maintain a healthy heart, not only as a preventative measure, but for treatment too. For starters, if you’re a smoker, quitting is very important and it increases heart rate, decreases oxygenated blood, and increases blood pressure. Furthermore, smokers are not considered for heart transplants.

Other lifestyle changes include maintaining a healthy body weight, meaning dropping excess weight, eating less salt, reducing your intake of alcohol, reducing ingested cholesterol and fat, reducing stress, and exercising more.

Prognosis of Acute Heart Failure

As long as acute heart failure is diagnosed in a timely manner and treatment begins immediately, the prognosis is good. Most patients are able to return back to their normal lives with little to no complications. It’s important that recommendations made by your doctor—either medically or lifestyle adjustments—are closely followed because, after acute heart failure, there is a higher risk of another cardiovascular event occurring.

The goal is to live as healthy as possible by making the right lifestyle choices including eating well, exercising, not smoking, reducing stress, and maintaining a healthy weight.