Jurding

AHF
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• diagnosis and initiation of treatment should
occur as early as possible, first 30–60 min
after hospital admission
 Clinical evaluation
Function:
• (i) assess severity of AHF
• (ii) confirm the diagnosis of AHF and
• (iii) identify precipitating factors of AHF
 congestion
• Since congestion is a typical feature of AHF,
patient history and physical examination
should primarily focus on the presence of
congestion.

• Left-sided congestion and Right-sided

congestion.
 Left-sided congestion
• dyspnoea, orthopnoea, bendopnoea,
paroxysmal nocturnal dyspnoea, cough,
tachypnoea, pathological lung auscultation
(rales, crackles, wheezing) and hypoxia.

• The absence of rales and a normal chest

radiography do not exclude the presence of
left-sided congestion
 Right-sided congestion
• increased body weight, bilateral peripheral
oedema, decreased urine output, abdominal
pain, nausea and vomiting, jugular vein
distension or positive hepato-jugular reflux,
ascites, hepatomegaly, icterus.
 hypoperfusion
• Symptoms and signs of hypoperfusion indicate
severity

• hypotension, tachycardia, weak pulse, mental

confusion, anxiety, fatigue, cold sweated
extremities, decreased urine output and
angina
 Hypoperfusion (cont..)
• The presence of inappropriate stroke volume
and clinical and biological signs of
hypoperfusion in AHF defines cardiogenic
shock, the most severe form of cardiac
dysfunction.
• patients may be classified in four groups.
– Congested and hypoperfused
– Congested but well perfused
– Not congested and hypoperfused
– Not congested, well-perfused

• This classification may help to guide initial

therapy (mostly vasodilators and/or diuretics)
and carries prognostic information.
 Additional tests
• Cardiac troponin
• chest X-ray
• Abdominal ultrasound
• Thoracic ultrasound
• Natriuretic peptides
 Reassessment and allocation
• The level of care should be based on
– history
– physical examination
– Biomarkers

• Low risk AHF patientsand with good response

to initial therapy may be considered for early
discharge.
 Pathophysiology-based management
• initial treatment of AHF patients should
include decongestive therapy and specific
therapy directed towards the underlying
causes of AHF

• early administration of oral disease-modifying

HF therapy before hospital discharge is
recommended
• decongestive therapy
– vasodilators and/or diuretics
• specific therapy
– revascularization, antiarrhythmic
treatments,antimicrobial drugs
• oral disease-modifying HF therapy
– beta-blockers, angiotensin-converting enzyme
inhibitors or angiotensin receptor blockers and
mineralocorticoid receptor antagonists