الفهرس 
Pathophysiology and Management of Acute Heart FailureOnly 14 pages are availabe for public view
 |  | from | 201 |  |  |
| | | from | 201 | | |
Abstract
Acute HF is defined as “a rapid onset or change in the
signs and symptoms of HF, resulting in the need for urgent
therapy.” It may be either new onset HF or worsening of preexisting
HF and that cardiac dysfunction may be related to
different causes, including acute coronary syndromes (ACS),
valve dysfunction, arrhythmias, pericardial disease, and
increased left ventricular (LV) afterload and that these different
causes may interact. Diagnosis of AHF is based on the
symptoms and clinical findings supported by appropriate
investigations.
Prompt recognition and treatment of any lifethreatening
illness is the first priority for any patient presenting
with signs and symptoms of AHF.
Multiple approaches have been proposed for dividing
AHF patients. The approach recommended here divides patients
based on initial systolic blood pressure into ٣ categories,
hypertensive (systolic blood pressure (SBP) > ١٤٠ mm Hg),
normotensive (SBP ٩٠–١٤٠ mm Hg) and hypotensive (SBP <
٩٠ mm Hg), with a distinct initial approach for each profile.
Hypertensive heart failure patients initial treatment
should focus on aggressive blood pressure control and
minimizing diuretic use. Normotensive heart failure patients benefit from aggressive diuresis, with a therapeutic goal of
relieving congestion and reducing total body fluid and
peripheral edema. Blood pressure can be controlled with topical
nitroglycerin, along with resuming the patient’s
antihypertensive regimen. Hypotensive heart failure patients
are more likely to receive intravenous inotropes during
hospitalization.
Worsening renal function occurs in ٢٠٪ to ٣٠٪ of AHF
patients during hospitalization. Renal dysfunction resulting
from neurohormonal or hemodynamic abnormalities
(vasomotor nephropathy) may be preventable or reversible and
it is often referred as the cardio-renal syndrome. Worsening of
renal function (WRF) during hospitalization for acute
decompensated heart failure (ADHF) patients is associated with
prolonged hospital stay, higher in-hospital mortality, increased
likelihood of readmission, and increased mortality after
discharge.