Acute heart failure

People with acute heart failure may find it difficult to breathe effectively and they may feel short of breath – this can come on over a few hours to days in acute heart failure. It’s often worse when lying flat and can feel uncomfortable or like you’re suffocating. You may also experience a cough with pink frothy sputum or a wheeze, as fluid builds up in the lungs.

Fluid can build up in the ankles and legs, and this can also affect the lower back if someone is bedbound or sitting for long periods, and the abdomen and the scrotum in men.

A combination of the above symptoms and the increased work of the heart will cause people with acute heart failure to feel very fatigued and tired. As people may have other chronic diseases which can come with their own symptoms, it can make identifying heart failure quite difficult. 

Heart failure can occur as a result of a number of conditions, mainly ones affecting the heart, such as a previous heart attack or irregularities of the heartbeat, such as atrial fibrillation; infections of the heart and coronary artery disease may also contribute.

You may have a problem with one of the valves in your heart – if this is leaking, blood can't effectively build up in one chamber of the heart to be pushed to the next and then around the body, or one of your coronary arteries could be blocked. Therefore the supply of blood to the heart is restricted. You may have been diagnosed with chronic heart failure, which is a long-term condition that requires medication and frequent reviews to manage it. Still, symptoms can sometimes suddenly worsen, causing acute-on-chronic heart failure.

Conditions in other organs can put a strain on the heart, such as a blood clot in the lungs, stroke, diabetes, and severe kidney disease.

It's mostly a condition affecting older people, although those born with heart problems – congenital heart disease – may develop heart failure earlier in life.

If you have difficulty breathing, leg swelling, a wet cough, and any reason to suspect you are at risk of acute heart failure, you should seek urgent medical attention – this can be an emergency doctors appointment or a visit to the Emergency Department. The doctor will take your medical history and examine your chest and lungs. Blood tests are done immediately to look for any other reason for your symptoms.

One particular blood test may take longer to come back, and this can identify whether there is evidence of heart failure. The doctor will order tests such as an ECG – to show the electrical activity of your heart, a chest X-ray, and an echocardiogram – an ultrasound scan of the heart – to look at the heart structure and how well it’s pumping.

Acute heart failure causes less blood to be pumped around the body, so less oxygen is able to reach the cells for our bodies to function effectively. Heart failure can be life-threatening, so seeking treatment quickly is important. Immediate treatment involves giving oxygen, medications that open up the narrowed blood vessels, and water tablets (diuretics) to remove excess fluid from the body and reduce the load on the heart.

You will be hospitalized while all of this is occurring in order to stabilize you as much as possible. Other medications lower the blood pressure and strengthen the contractions of the heart, to boost the pump action of the heart - these specific treatments will depend on your particular needs. A hospital team may suggest restricting your daily fluids to a certain level to try to encourage excess fluid to be removed via the kidneys and out via the urine. This is usually only a short-term measure.

Depending on the cause of your acute heart failure, the underlying reason will also need to be treated and managed and will be tailor-made from the outcome of investigations. This may need to be addressed gradually, or – in the case of surgery – it may be arranged for a later date.

You may have a leaky heart valve, in which case surgery to repair or replace the valve may fix the problem, or bypass surgery may be offered if one of your heart blood vessels is blocked. Devices such as pacemakers or implantable defibrillators may also be used. In severe cases, a heart transplant may be suggested.