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Acute Heart Failure

Last updated April 3, 2018

Approved by: Maulik P. Purohit MD, MPH

DoveMed found this great 3D animation to explain the definition of heart failure.

What are the other Names for this Condition? (Also known as/Synonyms) 

  • Acute Decompensated Heart Failure (ADHF)

What is Acute Heart Failure? (Definition/Background Information)

  • Acute heart failure (AHF) is a cardiovascular problem that arises when the heart is unable to pump adequate amounts of blood to meet the needs of the body.
  • Unlike chronic heart failure, AHF is characterized by the sudden, unpredictable onset of symptoms. While symptoms of heart failure are always present in these individuals, acute heart failure leads to a rapid change in symptoms that requires prompt emergency medical care.
  • Most cases of acute heart failure occur due to ongoing damage to the heart that weakens its muscles. Through muscle weakening, the heart is no longer able to keep up with the demands of the body, causing irregularities.
  • While heart failure can involve the left, right, or both ventricles of the heart, most cases begin in the left ventricle, which is the heart’s main pumping chamber. Often times it then spreads to the right ventricle and worsens apparent symptoms.

Who gets Acute Heart Failure? (Age and Sex Distribution)

  • Most cases of acute heart failure occur in individuals over the age of 55. It can, however, occur in people of all age groups.
  • It has been observed that acute heart failure and other forms of heart failure occur at a higher incidence rate in African Americans, Native Americans, and Hispanics compared to those of Caucasian descent. This is likely due to the higher prevalence of high blood pressure and diabetes in these population groups.
  • While men and women have the same incidence rate of acute heart failure, women are likely to suffer from it later in life and have been found to survive a longer period of time with heart failure than men do.

What are the Risk Factors for Acute Heart Failure? (Predisposing Factors) 

Common risk factors of acute heart failure include:

  • High blood pressure 
  • Coronary artery disease - symptoms include narrowing of arteries, which lowers the supply of blood and oxygen to the heart, leading to heart muscle weakness
  • Heart attack
  • Irregular heartbeat (arrhythmia) - heart muscles may exert more energy due to irregularity
  • Diabetes - increases risk of high blood pressure and coronary artery disease
  • Congenital heart defects - heart defects from birth can lead to acute heart failure

While one risk factor may be enough to cause acute heart failure, individuals with multiple risk factors have been found to have an increased risk of suffering from AHF as each risk factor causes more and more heart muscle damage.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Acute Heart Failure? (Etiology)

  • Acute heart failure can be caused by a variety of factors. In all cases, however, the underlying problem is muscle damage or weakness that prevents the heart from pumping adequate amounts of blood to support the activities of the body.
  • Structural abnormalities in the heart can cause acute heart failure. When the heart is damaged or there is a defect that changes its structure, proper blood pumping and circulation may not occur. This increases the burden on the heart and could lead to AHF.
  • Low oxygen levels in the heart can also cause acute heart failure. Without adequate oxygen, the heart muscles will not contract correctly, leading to low blood pumping.
  • Fever and infection have also been found to cause acute heart failure. When the body is in a weakened state, the heart often does not function at its best and could lead to low blood pumping characteristic of acute heart failure.
  • Genetics can also play a role in determining if acute heart failure will occur. Certain heart defects and congenital abnormalities have been found to arise due to genetic mutations. 

What are the Signs and Symptoms of Acute Heart Failure?

Common signs and symptoms of acute heart failure include:

  • Sudden shortness of breath
  • Coughing
  • Chest pain
  • Fatigue
  • Heart palpitations (rapid, irregular heart beat)
  • Swelling of the feet, ankles due to fluid buildup
  • Sudden weight gain
  • Decreased alertness

Many of these signs and symptoms are also found in individuals with chronic heart failure. The main difference is that people who are experiencing acute heart failure will find a sudden and rapid onset of these symptoms that quickly worsen.

How is Acute Heart Failure Diagnosed?

  • In most cases, acute heart failure is diagnosed after your doctor has conducted a physical examination. During the exam, your doctor will check to see if any of the common risk factors of AHF are present (high blood pressure, abnormal heart beat, congestion).
  • A blood test can also be used to diagnose acute heart failure. If kidney or thyroid functioning problems are noted, it may be an indication that heart problems also exist.
  • Chest x-rays are also a common tool in diagnosing AHF. By observing the condition of the lungs and heart and looking to see if fluid buildup or heart an enlargement is present, a diagnosis of acute heart failure can be made.
  • ECGs (electrocardiograms) observe electrical activity of the heart. If an abnormal heart rhythm or rate is noted, AHF is suspected.
  • An angiogram can also be conducted to identify if narrow arteries are present that may be causing the symptoms of acute heart failure. In this test, a catheter is put into a blood vessel of the groin or arm and guided through the body to the aorta. A dye is injected from the catheter that is visible in an x-ray that makes it apparent how the arteries are supplying blood to the heart. 
  • Due to the rapid and sudden onset of symptoms in acute heart failure, most people are in the emergency room by the time symptoms are apparent and severe enough to require medical attention. It is important to seek medical help as soon as symptoms arise, even if they are only slight changes. 

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Acute Heart Failure?

  • Complications may arise in other organs and systems of the body due to acute heart failure.
  • In most cases, heart failure reduced blood flow to the kidneys. Without treatment this can cause severe damage and result in kidney failure.
  • Fluid buildup in the heart can cause complications within the heart valves. If too much fluid is built up, the valves become stretched and damage resulting in abnormal blood flow to and from the heart.
  • Fluid buildup can also cause pressure to build up against the liver, resulting in liver damage. If it becomes excessive, scarring may result that impairs liver functioning.
  • Blood clots may also develop as a result of acute heart failure. In people with AHF, blood does not flow through the heart as quickly as it normally would. This increases the likelihood of blood clots forming and may result in a heart attack or stroke.

How is Acute Heart Failure Treated?

  • In most cases of acute heart failure, medications help to control symptoms and improve blood flow. A variety of medications are used, though the most common are:
    • Diuretics - cause frequent urination and prevent fluid collection in the body
    • Angiotensin-converting enzyme inhibitors - widen blood vessels and improve blood flow; decreases blood pressure and stress on heart muscles
    • Angiotensin II receptor blockers - work in the same manner as angiotensin-converting enzyme inhibitors
    • Digoxin - increases cardiac output by improving heart muscle contractions
    • Beta blockers - help reduce blood pressure and slow heart rate

Usually, multiple medications must be taken together to improve symptoms.

If the damage from acute heart failure is severe and likely to cause further, permanent problems, surgery may be suggested. Coronary bypass surgery, heart valve repair, or an insertion of a pace maker or defibrillator may be done.

How can Acute Heart Failure be Prevented?

  • The most important way to prevent acute heart failure from occurring is by taking measures to reduce the likelihood of developing the risk factors of the disease. The most effective way of reducing risk factors is by making lifestyle changes.
  • It is important to exercise and eat healthy to reduce your risk of developing acute heart failure. Similarly, it will help if stress levels are maintained. 

What is the Prognosis of Acute Heart Failure? (Outcomes/Resolutions)

  • With proper identification of symptoms and prompt treatment, most individuals who suffer from an acute heart failure are able to return to normal. Although their likelihood of developing further heart and organ problems is increased, with proper monitoring and medication, they are able to resume normal functioning.
  • It is important to have follow-up checkups following an acute heart failure to ensure that problems do not come on again.

Additional and Relevant Useful Information for Acute Heart Failure:

The following DoveMed website link is a useful resource for additional information:


What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Sept. 9, 2013
Last updated: April 3, 2018