Acute Decompensated Heart Failure: Presentation, Physical Exam, and Laboratory Evaluation

Abstract

ADHF may be a manifestation of any abnormality of cardiovascular function. Most patients have a prior history of heart failure. Patients with chronic heart failure may have a history of gradually worsening symptoms of pulmonary and systemic venous congestion over several days to weeks or may have more rapid development of symptoms commonly associated with a clear precipitant (examples: new onset atrial fibrillation with rapid ventricular response in a patient with HFpEF; ACS in a patient with an ischemic cardiomyopathy). Approximately 25 % of patients with ADHF have new onset or de novo heart failure-many of these patients have associated ACS or poorly controlled hypertension [1]. A minority of patients present with acute pulmonary edema. Patients with pulmonary edema have severe respiratory distress, tachypnea, tachycardia, hypox-emia, pulmonary rales, and radiographic evidence of pulmonary congestion. Some patients may need mechanical ventilation. The onset is frequently acute and associated with severe hypertension or atrial tachyarrhythmia (especially in patients with preserved systolic function) In EHFS II 16 % of patients presented with acute pulmonary edema [2]. In OPTIMIZE-HF, 2.5 % of patients presented in acute pulmonary edema [3]. In the ADHERE Registry, 4.5 % of patients required mechanical ventilation during hospitalization [4]. In ADHERE, the percentage of patients who required mechanical ventilation decreased from 5.3 to 3.4 % over 3 years (January 2002 to December 2004) [5]. A minority of patients present with cardiogenic shock. Cardiogenic shock is generally associated with heart failure complicating ACS. The ADHERE and