Acute Decompensated Heart Failure

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


RV heaves

LV heaves


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)


S3 and S4 heart sounds

Anasarca (massive generalized body edema)

Pleural effusion

Hepatomegaly (liver enlargement)

Changes in mental status

Restlessness, confusion



Weakness, fatigue

Anxiety, depression

Anxiety, depression

Dependent, bilateral edema


Right upper quadrant pain

Shallow respirations up to 32-40/min

Anorexia and GI bloating

Paroxysmal nocturnal dyspnea



Dry, hacking cough


Frothy, pink-tinged sputum (advanced pulmonary edema)


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