Heart failure often causes shortness of breath and swelling in the legs due to the heart's impaired ability to pump blood. People with worsening heart failure symptoms are said to have acute decompensated heart failure, or ADHF. This condition can develop abruptly or slowly, over several weeks. In either case, ADHF is associated with an increased risk of complications and even death relative to people with more stable heart failure.
Acute Decompensated Heart Failure
Acute decompensated heart failure is a leading cause of hospitalization; in 2011, it was the most common cause of hospital admission among people age 85 and older, reports the Agency for Healthcare Quality and Research. Fluid accumulation in the lungs and other organs is typically a hallmark of ADHF. Initial symptoms of mild shortness of breath and slight weight gain can progress to intense difficulty breathing and marked swelling in the legs and feet. Depending on the extent to which other organs are affected by ADHF, additional symptoms may include abdominal swelling, decreased urination and mental confusion.
In many cases, the precipitating cause of ADHF is unclear. Nevertheless, uncontrolled high blood pressure, underlying coronary artery disease, abnormal heart rhythms and certain medications, such as nonsteroidal antiinflammatory drugs, are common triggers. Other medical conditions, including diabetes, thyroid disorders, chronic obstructive pulmonary disease and pneumonia, may also contribute to decompensated heart failure. ADHF is often caused by missed doses of medications prescribed to treat heart failure.
Without treatment, ADHF can severely compromise breathing and limit blood flow to other organs. If profound respiratory distress develops, breathing support with a mechanical ventilator may be necessary until excess fluid is removed from the lungs. When fluid accumulates in the liver, the liver can become irritated and inflamed. In rare instances, this inflammation can progress to liver failure. If ADHF compromises blood flow to the kidneys, renal failure may ensue. When heart failure causes a drop in blood pressure that affects multiple organs, ADHF progresses to a condition known as cardiogenic shock.
The primary goals of treatment for ADHF are to reverse abnormal fluid accumulation and restore adequate blood flow. A diuretic medication is typically given by an intravenous infusion to eliminate excess fluid. In some cases, ultrafiltration, a procedure similar to dialysis, may be used to remove fluid from the body. Other intravenous medications, called inotropes, may also be given to help boost the pumping function of the heart. The American College of Cardiology recommends that a thorough evaluation be performed to identify and address potential ADHF triggers, including coronary artery disease, thyroid disease and abnormal heart rhythms, such as atrial fibrillation.
- Texas Heart Institute Journal: Acute Decompensated Heart Failure
- U.S. Pharmacist: Acute Decompensated Heart Failure
- Circulation: Atrial Fibrillation and Acute Decompensated Heart Failure
- Heart Failure Society of America: Evaluation and Management of Patients With Acute Decompensated Heart Failure
- Journal of the American College of Cardiology: 2013 ACCF/AHA Guideline for the Management of Heart Failure
- Agency for Healthcare Research and Quality: Most Frequent Conditions in U.S. Hospitals, 2011
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