Acute Decompensated Heart Failure

Clinical manifestation
- ADHF
  - Sudden onset of signs and symptoms of HF
  - Requires urgent medical care
  - Pulmonary and systemic congestion due to increased left-sided and right-sided filling pressures
- Early → increased pulmonary venous pressure
  - Increase in the respiratory rate
  - Decrease in PaO₂
- Later → interstitial edema
  - Tachypnea
- Further progression → alveolar edema
  - Respiratory academia
- Can manifest as pulmonary edema
- Life-threatening situation – alveoli fill with fluid
- Most commonly associated with left-sided HF

Right-sided heart failure	Left-sided heart failure
Signs
RV heaves	LV heaves
Murmurs	Pulsus alternans (alternating pulses: strong, weak)
Jugular venous distention	Increased HR
Edema (e.g., pedal, scrotum, sacrum)	PMI displaced inferiorly and left of the midclavicular line (LV hypertrophy)
Weight gain	Decreased PaO₂, slight increased PaCO₂ (poor O₂ exchange)
Increased HR	Crackles (pulmonary edema)
Ascites	S₃ and S₄ heart sounds
Anasarca (massive generalized body edema)	Pleural effusion
Hepatomegaly (liver enlargement)	Changes in mental status
	Restlessness, confusion
Symptoms
Fatigue	Weakness, fatigue
Anxiety, depression	Anxiety, depression
Dependent, bilateral edema	Dyspnea
Right upper quadrant pain	Shallow respirations up to 32-40/min
Anorexia and GI bloating	Paroxysmal nocturnal dyspnea
Nausea	Orthopnea
	Dry, hacking cough
	Nocturia
	Frothy, pink-tinged sputum (advanced pulmonary edema)

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