Fast Five Quiz: Acute Heart Failure Presentation and Diagnosis

Arnold S. Baas, MD; Jeff Hsu, MD

Disclosures

May 12, 2020

Figure 2. Heart failure before (left) and after (right) treatment.

Hepatomegaly is a cardinal feature in patients with chronic right-sided heart failure, but it can also occur rapidly in acute heart failure. In such cases, the liver is typically tender.

Acute pulmonary edema, or the sudden increase in pulmonary capillary wedge pressure (usually > 25 mm Hg), is the result of acute and fulminant left ventricular failure and has a dramatic presentation. Patients with acute pulmonary edema appear extremely ill and are poorly perfused, restless, sweaty, tachypneic, tachycardic, hypoxic, and coughing, with increased work of breathing and use of respiratory accessory muscles and with frothy sputum that may be blood-tinged.

Jugular venous distention is a manifestation of systemic venous hypertension. Elevated jugular venous pressure is indicative of increased right atrial pressure and right-sided heart failure, and it is generally the most reliable indicator of volume overload in older patients.

In patients with very severe heart failure, particularly if cardiac output has declined acutely, systolic arterial pressure may be reduced. The pulse may be weak, rapid, and thready; the proportional pulse pressure (pulse pressure/systolic pressure) may be noticeably diminished.

Learn more about the signs and symptoms of acute heart failure.

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