UPDATE IN ACUTE HEART FAILURE 2015

Anjarwani, S
Department of Cardiology and Vascular Medicine – Faculty of Medicine Brawijaya University
Dr Saiful Anwar General Hospital, Malang, Indonesia

Acute heart failure is defined as the rapid development or change of symptoms and signs of
heart failure that requires urgent medical attention and usually hospitalization. Acute heart failure is
the first reason for hospital admission in individuals aged 65 or more and accounts for nearly 70% of
the total health care expenditure for heart failure.
Peripheral and/or pulmonary congestion is the hallmark of acute heart failure, resulting from
fluid retention and/or fluid redistribution. Myocardial injury and renal dysfunction are also involved
in the precipitation and progression of the syndrome.
The management of acute heart failure syndrome is challenging, given the heterogeneity of
the patient population, in terms of the clinical presentation, pathophysiology, prognosis, and
therapeutic options . As for acute coronary syndromes, the “time-to-treatment” concept may be
important in patients with AHF. Hence, all AHF patients should receive appropriate therapy as early
as possible. Determination of cardiopulmonary stability is the critical first step. Patients with
respiratory failure or hemodynamic compromise should be triaged to a location where immediate
respiratory and cardiovascular support can be provided. The unnecessary admissions should be
avoided and reducing hospitalization rate for AHF patients would probably reduce costs.
The management of acute heart failure syndrome is a dynamic process, requiring ongoing
simultaneous diagnosis (monitoring) and treatment. Pharmacological agents remain the mainstay of
therapy for acute heart failure syndrome. However, at all time, during the early diagnostic, aetiologic,
and therapeutic work-up, non-pharmacologic therapy may be indicated and should be considered.
The management of the complex cardiac patient with acute heart failure syndrome and/or
(potential) haemodynamic compromise has become a special dimension for specialized myocardial
intervention centres, providing 24 hours per day and 7 days per week facilities for (primary)
percutaneous coronary intervention and cardiac intensive care, including mechanical ventilation,
ultrafiltration, with or without dialysis, and short-term percutaneous mechanical circulatory support.

Keyword : acute, heart, failure, management