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Acute heart failure is a life-threatening condition that requires prompt intervention.However, the correct management should be guided by the clinical context. “We should never look at heart failure as a diagnosis in itself,” says Doctor Brenda Moura (Hospital das Forças Armadas, Porto, Portugal), a speaker at today’s session ‘Acute heart failure: do clinical settings matter?’, “we should always look for the cause and precipitating factors.”
Dr. Moura goes on to explain that in acute heart failure, it is always important to find the trigger so that treatment can be directed towards it; for example, revascularisation in a patient with acute coronary syndrome, or cardioversion in a patient presenting with an atrial or ventricular arrhythmia. Only if the aetiology is addressed can the correct treatment be provided to improve the outlook for patients.
The importance of investigating the acute aetiology in a patient with suspected acute heart failure is underlined by its inclusion in the diagnostic algorithm of the 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.1 The Guidelines stress that investigations should be conducted within the first 1–2 hours, immediately after addressing cardiogenic shock or respiratory failure issues. “The leading causes of acute heart failure are captured by the CHAMP acronym—acute Coronary syndrome, Hypertension emergency, Arrhythmia, acute Mechanical cause and Pulmonary embolism—and we should keep this acronym in mind whenever we are faced with a patient who appears to be in acute heart failure,” says Dr. Moura.
As signs and symptoms have poor sensitivity and specificity, a successive battery of tests, including a chest X-ray, an electrocardiogram, an echocardiogram and blood tests are mandatory and will lead to the correct diagnosis in most situations. If pulmonary embolism is suspected, D-Dimer and computed tomography angiography will also be required to achieve a definitive diagnosis. If one of these conditions is detected, specific treatment, ranging from drugs to surgery, should be initiated immediately. However, if these acute aetiologies are excluded, other precipitating factors should be investigated, with infection, rhythm disturbances, hypertension and non-adherence to treatment being the most frequent causes.
The CHAMP acronym should always be kept in mind when faced with a patient with suspected acute heart failure.
“We should always think about aetiology and precipitating factors and look out for distinctive signs in the patient with acute heart failure. Only in this way we will be capable of providing appropriate and timely treatment for our patients and of improving their prognosis,” concludes Dr. Moura.
‘Acute heart failure: do clinical settings matter?’
Sunday, 16:30 – 18:00; Lambrakis
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