From the Guidelines
Heart failure exacerbation is typically caused by a combination of factors, including decompensation of pre-existing chronic heart failure, acute coronary syndromes, hypertensive crisis, acute arrhythmia, and non-cardiovascular precipitating factors such as lack of compliance with medical treatment, volume overload, infections, and severe brain insult 1.
Common Causes of Heart Failure Exacerbation
- Cardiac causes:
- Decompensation of pre-existing chronic heart failure (e.g. cardiomyopathy)
- Acute coronary syndromes (e.g. myocardial infarction, unstable angina)
- Hypertensive crisis
- Acute arrhythmia (e.g. ventricular tachycardia, atrial fibrillation)
- Valvular regurgitation (e.g. endocarditis, rupture of chordae tendinae)
- Severe aortic valve stenosis
- Acute severe myocarditis
- Cardiac tamponade
- Aortic dissection
- Post-partum cardiomyopathy
- Non-cardiac causes:
- Lack of compliance with medical treatment
- Volume overload
- Infections (e.g. pneumonia, sepsis)
- Severe brain insult
- After major surgery
- Reduction in renal function
- Asthma
- Drug abuse
- Alcohol abuse
- Phaeochromocytoma
High Output Syndromes
- Septicaemia
- Thyrotoxicosis crisis
- Anaemia
- Shunt syndromes These causes can lead to a rapid deterioration of cardiac function, resulting in heart failure exacerbation, which requires immediate medical attention 1. It is essential to identify and address the underlying cause of the exacerbation to provide effective treatment and prevent further complications 1.
From the Research
Causes of Heart Failure Exacerbation
The causes of heart failure exacerbation can be varied and complex. Some of the key factors that contribute to heart failure exacerbation include:
- Noncompliance with salt restriction 2
- Noncardiac causes, such as pulmonary infectious processes 2
- Use of certain medications, including antiarrhythmic agents, calcium channel blockers, and inappropriate reductions in heart failure therapy 2
- Arrhythmias 2
- Study medications 2
Precipitants of Congestive Heart Failure Exacerbations
Research has identified several precipitants of congestive heart failure exacerbations, including:
- Ischemia 2
- Arrhythmias 2
- Hypertension 3
- Fluid overload 4, 3
- Infection 2
- Non-adherence to medication or diet 2
Triggers of Acute Heart Failure
Acute heart failure can be triggered by a variety of factors, including:
- Sudden onset of severe pulmonary edema and hypertension, resulting in respiratory distress and hypoxemia, also known as sympathetic crashing acute pulmonary edema (SCAPE) 3
- Flash pulmonary edema 4
- High-output heart failure 4
- Cardiogenic shock 5, 4
Management of Heart Failure Exacerbation
The management of heart failure exacerbation typically involves a combination of pharmacological and non-pharmacological interventions, including: