From the Guidelines
The most common reasons for acute congestive heart failure are coronary heart disease, decompensation of pre-existing chronic heart failure, acute coronary syndromes, hypertensive crisis, and acute arrhythmia. According to the European Society of Cardiology guidelines 1, coronary heart disease is the aetiology of acute heart failure (AHF) in 60-70% of patients, particularly in the elderly population. Decompression of pre-existing chronic heart failure is also a common cause, as patients with chronic heart failure are at increased risk of decompensation due to various factors such as non-compliance with medication, volume overload, or infections 1. Acute coronary syndromes, including myocardial infarction, unstable angina, and mechanical complications of acute myocardial infarction, can also lead to AHF 1. Hypertensive crisis and acute arrhythmia, such as ventricular tachycardia or atrial fibrillation, are other common causes of AHF 1.
Some key points to consider in the management of AHF include:
- Identifying and addressing the underlying cause of AHF
- Providing immediate treatment with diuretics, oxygen therapy, and other supportive measures as needed
- Considering the patient's age, comorbidities, and other factors that may impact management, such as renal function and polypharmacy 1
- Developing an individualized treatment plan that takes into account the patient's unique needs and circumstances
It is essential to note that AHF is a life-threatening condition that requires urgent treatment, and prompt intervention can significantly improve outcomes by reducing cardiac workload and preventing further damage to the heart muscle 1. Patients experiencing symptoms of AHF should seek emergency care immediately.
From the Research
Common Reasons for Acute Congestive Heart Failure
The most common reasons for acute congestive heart failure include:
- Myocardial infarction (MI), which is a term used for an event of heart attack due to formation of plaques in the interior walls of the arteries resulting in reduced blood flow to the heart and injuring heart muscles because of lack of oxygen supply 2
- Hypertension, which is the most common cardiovascular risk factor and underlies heart failure, coronary artery disease, stroke, and chronic kidney disease 3
- History of hypertension, which is a frequent finding in patients with acute myocardial infarction (AMI) and its recurring association with female sex, diabetes, older age, less frequent smoking and more frequent vascular comorbidities composes a risk profile quite distinctive from the normotensive ischemic counterpart 4
- Atherosclerosis, which is induced by hypertension and contributes to the development of myocardial infarction, and left ventricular hypertrophy, which is a linking factor that is induced by hypertension and contributes to the development of atherosclerosis and myocardial infarction 5
Underlying Causes
The underlying causes of acute congestive heart failure include:
- Formation of plaques in the interior walls of the arteries resulting in reduced blood flow to the heart and injuring heart muscles because of lack of oxygen supply 2
- Mechanical stress on blood vessels because of high blood pressure, which is an especially important factor in endothelial dysfunction, the progression of atherosclerosis, and plaque rupture 5
- Activation of the renin-angiotensin-aldosterone system, which induces conversion of fibroblasts into myofibroblasts, promoting deposition of extracellular matrix proteins 6