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) | |
