Acute Decompensated Heart Failure Treatment- Cardiology

Acute Decompensated Heart Failure

Acute decompensated heart failure necessitates prompt medical attention as the heart cannot do its job. Although the heart is still beating, it cannot supply the body with enough oxygen. The signs and symptoms can appear gradually or suddenly. The condition may be fatal and requires urgent medical care.

Understanding Acute Decompensated Heart Failure

Acute decompensated heart failure (ADHF) is a rapid or gradual onset of heart failure symptoms. People with ADHF commonly exhibit different heart failure symptoms, such as poor blood flow and bodily fluid accumulation. As a result, they require immediate medical attention.

According to research, ADHF is a distinct clinical illness with specific underlying reasons rather than just a worsening of chronic heart failure. As a result, it needs particular treatment.

When the heart cannot pump blood like the heart of a healthy individual, the body's cells do not receive enough blood that is rich in oxygen and nutrients. The body then compensates for cardiac failure by various mechanisms.

First, the heart enlarges and stretches to pump more blood and ensure enough blood reaches the body. It increases muscle mass and pumps more forcefully and faster. Additionally, the heart constricts the blood vessels, increasing blood pressure. Finally, the body prioritizes the blood flow to the most vital organs and tissues instead of organs like the kidneys.

When heart failure progresses, these compensatory mechanisms are insufficient to keep the body functioning normally. The resultant symptoms include weariness and shortness of breath.

An article from 2021 claims that ADHF may happen when volume overload and congestion (when the body has too much fluid buildup) become too much for the body to handle. The symptoms of ADHF are brought on by increased pressure in the right, left, or both bottom chambers of the heart.

Underlying health conditions like diabetes, coronary artery disease, and high blood pressure can raise the risk of ADHF. In addition, pneumonia, heart attack, uncontrolled high blood pressure, atrial fibrillation (abnormal heart rhythms), diet, medication, or failure to maintain fluid restriction are some of the causes of decompensated heart failure.

Anemia and hyperthyroidism are two other well-known triggering conditions that stress the heart muscle more. Decompensation may also be triggered by excessive salt or fluid intake and drugs like NSAIDs and thiazolidinediones that produce fluid retention.

Who Are At Risk For Acute Decompensated Heart Failure?

Risk factors for acute decompensated heart failure are the following:

• Acute coronary syndrome results in a sudden, decreased blood flow to the heart
• Diabetes
• High blood pressure
• Ischemic heart disease
• Being of older age
• A history of transient ischemic attack or stroke
• Chronic obstructive pulmonary disease
• Chronic kidney disease
• A history of heart attack, infections, or heart bypass surgery

Diagnosis

Healthcare professionals do a quick evaluation that includes:

1. Your medical history, including any family or personal history of heart disease. They will also ask about your other medical conditions, such as if you smoke and what drugs you take.
2. A physical examination to determine the extent of your symptoms and learn more about them. This includes listening to your heartbeat and looking for signs of edema.
3. Medical professionals may perform several tests to evaluate your symptoms. These include:
   • X-ray of the chest to look for fluid accumulation in the heart or lungs.
   • Electrocardiogram (EKG) to measure and record the heart's electrical activity.
   • Echocardiogram to assess heartbeat and blood flow.
   • Angiography or cardiac catheterization to look at the blood vessels in the heart.
4. You could also require the following lab tests:
   • A BNP (biomarker) blood test is used to look for hormones produced when the pressure inside the heart changes.
   • A basic metabolic panel that reveals thyroid or kidney problems.

Treatment For Acute Decompensated Heart Failure

The main goal in acute decompensated heart failure is to restore adequate blood flow and oxygen delivery to the organs. Ensuring the airway, breathing, and circulation are functioning correctly is vital. The head is raised throughout treatment, and oxygen is administered to treat hypoxemia.

Using a mask, you can breathe in additional oxygen provided by a supplemental oxygen apparatus.

Vasodilators are drugs that widen blood vessels to give your organs more blood. Diuretics, sometimes known as water tablets, help the body get rid of extra water.

Let’s look at the specific treatments below.

Medications

Beta-blockers

Drugs called beta-blockers prevent the release of adrenaline, which lowers the heart's workload. As a result, patients with ADHF, who are on beta-blockers, may have a decreased chance of death 60 to 90 days after leaving the hospital compared to those who do not.

ACE inhibitors and angiotensin receptor blockers (ARBs)

Medication to lower high blood pressure includes angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors. They might improve the outcome of cardiovascular diseases. ARBs and ACE inhibitors may aid in lowering hospital readmission and mortality rates related to ADHF.

Diuretics

Diuretics are drugs that assist the body in excreting extra water and salt through the urine. As a result, Diuretics may aid in preventing fluid accumulation in ADHF. In addition, doctors may prescribe diuretics called mineralocorticoid receptor antagonists (MRA), like spironolactone and eplerenone, to treat heart failure.

Digoxin

Digoxin can potentially treat heart failure and lower readmission rates in patients with specific forms of left-sided heart failure.

Ivabradine

Ivabradine may be able to stop heart failure from getting worse. So, in addition to beta-blockers, doctors may also prescribe ivabradine.

Surgery

Several situations require urgent consultation with a cardiothoracic surgeon. Aortic regurgitation-related heart failure is a surgical emergency with a significant fatality rate. After a ventricular aneurysm ruptures, heart failure could result. They may develop following myocardial infarction. Other conditions that may require surgical treatments are:

• Rupture of a ventricular aneurysm
• Cardiac tamponade

Doctors occasionally advise surgery to address the underlying issue that caused heart failure. Several procedures, such as coronary artery bypass surgery, heart valve repair or replacement, or heart transplantation, may be required depending on the underlying cause. Devices including pacemakers, defibrillators, and cardiac pumps may be installed during these surgeries.

Bypass surgery

In bypass surgery, the blocked artery in the heart is replaced by a vein from the chest, arm, or leg. This makes it possible for the heart to pump blood more efficiently.

Valve repair

By eliminating extra tissue from the valves that makes them close too tightly, valve repair modifies the valve causing heart failure. The ring around the valves must occasionally be replaced, which calls for an annuloplasty. If the valve cannot be repaired, it is replaced with an artificial heart valve.

Pacemaker

A pacemaker is a tiny device implanted in the chest or belly to help control irregular heartbeats. They are used to treat individuals with arrhythmias and work by electrically stimulating the heart so that it beats at a rate that is regarded as normal. For example, they can treat hearts that are either tachyarrhythmic (beating too quickly) or bradyarrhythmic (beating too slowly).

Angioplasty

An angioplasty is another common operation performed to treat individuals with heart failure. This procedure reduces the risk of death, decreases heart muscle damage after a heart attack, and relieves coronary artery disease (CAD) symptoms. During this treatment, a balloon is inserted into the heart to unblock an artery blocked due to atherosclerosis or a buildup of plaque on the artery walls. This surgery can help people suffering from heart failure due to CAD or a recent heart attack.

Heart replacement

This is the last option. The diseased heart needs to be replaced when significant heart failure is present and treatments like medications or other heart surgeries do not work.

Outlook

You might require drugs like beta blockers or diuretics to maintain optimal heart health after leaving the hospital. Additional therapies could also be necessary to prevent future acute heart failure episodes.

Acute decompensated heart failure could be worse than a heart attack. Up to 50% of cases with ADHF could lead to hospitalization or death within six months of the disease's onset.

Thorough monitoring of the condition is crucial in the first 30 days following hospital discharge to prevent the worsening of ADHF and readmission. In addition, treatment with drugs is essential both during and after hospitalization for ADHF. This will control the condition better and improve the quality of life.

Experts are still investigating the condition for a complete understanding of ADHF. Further research may help manage and treat the condition better and improve outcomes.

References:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2801958/
• https://mayoclinic.pure.elsevier.com/en/publications/acute-decompensated-heart-failure-and-the-cardiorenal-syndrome
• https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.121.318186

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