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