Acute Decompensated Heart Failure

Acute decompensated heart failure (ADHF) is a condition defined by worsening heart failure (HF) symptoms (dyspnea, orthopnea, lower limb swelling) and signs (elevated jugular venous pressure, pulmonary congestion). Classification of ADHF is complex due to the broad spectrum of presentation, onset, and symptoms. Patients with isolated right-sided HF usually suffer from severe tricuspid regurgitation or pulmonary stenosis (PS), severe pulmonary disease, severe pulmonary hypertension, or acute pulmonary embolism. Patients are often oxygen dependent and will present with evidence of severe systemic volume overload. Hemodynamic assessment using a pulmonary artery catheter is useful in evaluating and managing selected ADHF patients. Endomyocardial biopsy is very useful when fulminant myocarditis is suspected. ADHF patients with high blood pressure who present with shortness of breath and even pulmonary edema will have a generally favorable response to vasodilators. Vasopressors should be avoided in ADHF patients unless used to treat the hypotension induced by inotropes, mostly milrinone and levosimendan.