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
- ADHF
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) |