What is new in the diagnostics and treatment of acute heart failure

Acute heart failure (AHF) is the term used to describe a rapid onset or changes in the symptoms and signs of heart failure. It is a life-threatening condition that requires immediate attention and medical care and usually leads to an emergency hospital admission. In most cases, AHF is a result of deterioration of health in patients with previously diagnosed chronic heart failure (CHF) whether with reduced (HF-REF) or preserved (HF-PEF) left ventricular ejection fraction (EF). Heart failure is defined as an abnormality of cardiac structure or function, which leads to the inability of the heart to deliver oxygen at a rate which is adequate to the requirements of metabolism in tissues, despite normal cardiac filling pressure (or only at the cost of increased filling pressure). The most common causes of AHF are myocardial diseases which lead to ventricular dysfunction and a reduction in cardiac ejection fraction but also the abnormality of diastolic function or heart valve disease, pericardium, endocardium and heart rhythm disorders. In suspected AHF there are two approaches for exact diagnosis: through the use of rapid essay of BNP hormones or by echocardiographic examination with measurement of ejection fraction or diastolic anomalies and myocardial hypertrophy. Acuteness may vary, from the situation that within a few days there occurs a deterioration (dyspnea or edema) in some patients, while others develop AHF within a few minutes or hours (e.g., in acute myocardial infarction). The patient may have a range of conditions, from life-threatening pulmonary edema or cardiogenic shock, to the clinical picture that is primarily characterized by worsening of peripheral edema. Diagnosis and treatment are carried out concurrently, especially in seriously ill patients and all measures must be applied quickly. Continuous monitoring of the patient's vital functions is essential during the initial evaluation and treatment and certain patients are best treated in the intensive or coronary care unit like patients with acute coronary syndromes. Long-term goals of the treatment are the prevention of recurrent AHF and improvement of prognosis. 5 aspects are evaluated simultaneously: adequacy of ventilation, presence of threatening arrhythmias, state of tension (hypotension, shock), presence of acute coronary syndrome and acute mechanical reasons. All these evaluations should lead to a rapid response to the presence of a threatening condition, such as, for example, urgent revascularization and so on. Changes in the treatment strategy are early administration of vasodilatators and diuretics therapy for target organs protection(heart, liver and kidnies) in relation to mortality reduction. Key medications in AHF are the same as in the CHF: oxygen therapy, diuretics and vasodilators. Opiates and inotropic drugs are used more selectively and mechanical circulatory support devices only rarely. Non-invasive ventilation becomes a common practice, while invasive ventilation is required in a small number of cases. Systolic pressure, heart rate and frequency, and peripheral blood saturation and diuresis should be measured and often repeated until the patient becomes stable. All aspects are summarized in the algorithm AHF of the European Society of Cardiology (ESC).