Chih-Hsin Hsu

By Chih-Hsin Hsu and Wei-Ting Li

Acute heart failure is a life-threatening medical condition. Improving acute heart failure care is important. Early diagnosis and evaluating the etiology are important in acute heart failure. Patients with suspected acute heart failure should have a diagnostic workup, and appropriate pharmacological and nonpharmacological management should be started promptly and in parallel. Diagnosis of acute heart failure should be based on history and symptoms. The physical examination typically presents with some combination of increased congestion and decreased peripheral perfusion, further confirmed by electrocardiogram, chest radiograph, biomarkers, and echocardiogram. The first step in the management of a patient is to address life-threatening issues. Patients with respiratory failure or cardiogenic shock should be treated soon. The next step is the identification of precipitants that needs urgent management. Evidence-based medication to reduce morbidity and mortality for patients with heart failure includes an angiotensin converting enzyme inhibitor, angiotensin receptor blocker, or angiotensin receptor-neprilysin inhibitor; a beta blocker; and a mineralocorticoid receptor antagonist. During an acute heart failure episode, management of these agents depends upon whether the patient has contraindications to therapy such as hemodynamic instability or acute kidney injury. Once the patient is stable, therapies are carefully initiated, reinitiated, or titrated with appropriate follow-up.

Part of the book: Topics in Heart Failure Management