ACUTE HEART FAILURE:

INITIAL ASSESSMENT AND TRIAGE

WORKSHOP: HEART FAILURE-MAKE IT EASY

ANGGORO BUDI HARTOPO

WHAT IS HEART FAILURE?
• Chronic Heart Failure (CHF):
• a complex syndrome in which abnormal
heart function results in clinical symptoms
and signs of low cardiac output and/or
pulmonary or systemic congestion.

• Acute Heart Failure Syndrome (AHF):

• gradual or rapid change in heart failure
signs and symptoms resulting in the need
for urgent therapy.
ACUTE HEART FAILURE
•Rapid onset or worsening of
symptoms and/or signs of HF.
•A life-threatening medical condition
requiring urgent evaluation and
treatment.
•Typically leading to urgent hospital
admission
ACUTE HEART FAILURE

•A first occurrence (de novo)

•An acute decompensation of
chronic HF
CLASSIFICATION OF ACUTE HEART FAILURE

ESC 2008
PRECIPITATING FACTORS
CLINICAL PROFILES ACUTE HEART FAILURE

WARM- WARM-
DRY WET

COLD- COLD-
DRY WET
CLINICAL CLASSIFICATION

• warm and wet (well perfused and congested)

• cold and wet (hypoperfused and congested)
• cold and dry (hypoperfused without congestion)
• warm and dry (compensated, well perfused
without congestion)

➔ guide therapy in the initial phase

➔ prognostic information.
Diagnosis and initial prognostic evaluation
• to rule out alternative causes (i.e. pulmonary infection, anaemia,
acute renal failure).
• Initial diagnosis:
1. thorough history assessing symptoms
2. prior cardiovascular history
3. cardiac and non-cardiac precipitants,
4. assessment of signs/symptoms of congestion and/or
hypoperfusion (physical examination)
5. confirmed by appropriate additional investigations (ECG, chest
X-ray, laboratory assessment (with specific biomarkers) and
echocardiography)
INITIAL EVALUATION

Initial evaluation and continued non-invasive monitoring:

• patient’s vital cardiorespiratory functions: including pulse

oximetry, blood pressure, respiratory rate and a continuous
ECG instituted within minutes.

• urine output should also be monitored, although routine

urinary catheterization is not recommended.
 INTENSIVE HOSPITALISATION

• The criteria for ICU/CCU admission include any of the following:

– need for intubation (or already intubated)
– signs/symptoms of hypoperfusion
– oxygen saturation (SpO2) <90% (despite supplemental oxygen)
– use of accessory muscles for breathing, respiratory rate >25/min
– heart rate <40 or >130 bpm, SBP <90 mmHg.
Management of the early phase oxygen
therapy and/or ventilatory support
Left-sided congestion: orthopnoea, paroxysmal nocturnal dyspnoea,
breathless, bi-basilar rales, an abnormal blood pressure response to the
Valsalva maneuver .
Right-sided congestion: symptoms of gut congestion, jugular venous
distension, hepatojugular reflux, hepatomegaly, ascites, and peripheral
oedema.
DIURETICS
VASODILATORS
INOTROPIC , VASOPRESSORS
Management of patients with cardiogenic shock
Cardiogenic shock is defined as hypotension (SBP <90 mmHg)
despite adequate filling status with signs of hypoperfusion
Management of patients
with cardiogenic shock
-Matur Nuwun-