Understanding acute heart failure: Pathophysiology and diagnosis

Abstract

Acute heart failure (AHF) is a relevant public health problem causing the majority of unplanned hospital admissions in patients aged of 65 years or more. AHF was historically described as a pump failure causing downstream hypoperfusion and upstream congestion. During the last decades a more complex network of interactions has been added to the simplistic haemodynamic model for explaining the pathophysiology of AHF. In addition, AHF is not a specific disease but the shared clinical presentation of different, heterogeneous cardiac abnormalities. Persistence of poor outcomes in AHF might be related to the paucity of improvements in the acute management of those patients. Indeed, acute treatment of AHF still mainly consists of intravenous diuretics and/or vasodilators, tailored according to the initial haemodynamic status with little regard to the underlying pathophysiological particularities. Therefore, there is an unmet need for increased individualization of AHF treatment according to the predominant underlying pathophysiological mechanisms to, hopefully, improve patient's outcome. In this article we review current knowledge on pathophysiology and initial diagnosis of AHF.