Approach to Acute Heart Failure in the Emergency Department

Benton Hunter, Jennifer Martindale, Osama Abdel-Hafez, Peter Pang

Research output: Contribution to journalReview article

9 Citations (Scopus)

Abstract

Acute heart failure (AHF) patients rarely present complaining of ‘acute heart failure.’ Rather, they initially present to the emergency department (ED) with a myriad of chief complaints, symptoms, and physical exam findings. Such heterogeneity prompts an initially broad differential diagnosis; securing the correct diagnosis can be challenging. Although AHF may be the ultimate diagnosis, the precipitant of decompensation must also be sought and addressed. For those AHF patients who present in respiratory or circulatory failure requiring immediate stabilization, treatment begins even while the diagnosis is uncertain. The initial diagnostic workup consists of a thorough history and exam (with a particular focus on the cause of decompensation), an EKG, chest X-ray, laboratory testing, and point-of-care ultrasonography performed by a qualified clinician or technologist. We recommend initial treatment be guided by presenting phenotype. Hypertensive patients, particularly those in severe distress and markedly elevated blood pressure, should be treated aggressively with vasodilators, most commonly nitroglycerin. Normotensive patients generally require significant diuresis with intravenous loop diuretics. A small minority of patients present with hypotension or circulatory collapse. These patients are the most difficult to manage and require careful assessment of intra- and extra-vascular volume status. After stabilization, diagnosis, and management, most ED patients with AHF in the United States (US) are admitted. While this is understandable, it may be unnecessary. Ongoing research to improve diagnosis, initial treatment, risk stratification, and disposition may help ease the tremendous public health burden of AHF.

Original languageEnglish (US)
Pages (from-to)178-186
Number of pages9
JournalProgress in Cardiovascular Diseases
Volume60
Issue number2
DOIs
StatePublished - Sep 1 2017

Fingerprint

Hospital Emergency Service
Heart Failure
Blood Vessels
Shock
Sodium Potassium Chloride Symporter Inhibitors
Diuresis
Nitroglycerin
Vasodilator Agents
Respiratory Insufficiency
Hypotension
Ultrasonography
Electrocardiography
Differential Diagnosis
Thorax
Therapeutics
Public Health
History
X-Rays
Blood Pressure
Phenotype

Keywords

  • Acute heart failure
  • Decompensated heart failure
  • Emergency department
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Approach to Acute Heart Failure in the Emergency Department. / Hunter, Benton; Martindale, Jennifer; Abdel-Hafez, Osama; Pang, Peter.

In: Progress in Cardiovascular Diseases, Vol. 60, No. 2, 01.09.2017, p. 178-186.

Research output: Contribution to journalReview article

Hunter, Benton ; Martindale, Jennifer ; Abdel-Hafez, Osama ; Pang, Peter. / Approach to Acute Heart Failure in the Emergency Department. In: Progress in Cardiovascular Diseases. 2017 ; Vol. 60, No. 2. pp. 178-186.
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