Acute Heart Failure

Acute heart failure, or acute decompensated heart failure, refers to a sudden worsening of the signs and symptoms of heart failure. It can represent a worsening of a previously stable, compensated heart failure condition, or a first presentation of heart failure.

Patients develop worsening shortness of breath due to lung congestion. Patients can also observe worsening swelling of the lower limbs or abdomen, accompanied by sudden weight gain.

Common causes of acute heart failure include:

• Acute myocardial infarction ('heart attack')
• Abnormal heart rhythm
• Uncontrolled hypertension
• Infections
• Poor compliance to medication
• Fluid or salt indiscretion

• Shortness of breath
• Decreasing effort tolerance
• Difficulty in breathing when lying flat
• Waking up breathless at night
• Swelling of ankles/ legs/ abdomen
• Abrupt decrease in urine output

Acute heart failure is diagnosed by cardiologists, by integrating various clinical information, including:

• Patient symptoms
• Clinical examination findings
  • Signs of heart failure/ fluid retention
• Laboratory tests
  • Troponin levels: a protein released following heart muscle damage, to look for any evidence of acute myocardial infarction ('heart attack')
  • NT-proBNP: hormone produced by the heart, which is markedly elevated in acute heart failure
• Electrocardiogram ('ECG')
  • Electrical tracing of the heart, looking for evidence of acute myocardial infarction
• Chest radiograph
  • X-ray of the chest to look for abnormal heart enlargement/ abnormal fluid collection in the lungs
• Echocardiogram
  • Ultrasound examination which allows doctors to assess heart function and find out the cause of acute heart failure
• Invasive tests
  • Coronary angiogram: look for presence of blood vessel blockages which can account for the sudden weakening of the heart
  • Right heart catheterisation: invasive procedure that introduces a pressure monitoring catheter into the right side of the heart. The right heart catheterisation findings will allow us to adjust the patient's medications and reduce congestion

Immediate diagnosis of this condition and prompt treatment can prevent progressive worsening, thus improving patient symptoms.  The treatment options include:

• Medications that relief congestion
  • Diuretics: medications that cause the kidneys to produce more urine, thus relieving the congestion
  • Vasodilators: medications that relax the blood vessels, thus relieving the stress on the heart muscles
• Coronary angioplasty ('stenting procedure')
  • In patients who do not respond adequately to decongesting medications, a catheter can be introduced into a big vein and excess fluids can be mechanically drawn out using special equipment, in a process called 'ultrafiltration/ aquaphresis'

At the National University Heart Centre, Singapore (NUHCS), a multi-disciplinary Heart Failure Team is available for the prompt diagnosis and treatment of patients with acute heart failure. This allows for rapid improvement of patients' symptoms and reducing the need for prolonged hospital stay.