Assessment of Critically Ill Patients with Acute Heart Failure Syndromes Using Echocardiography Doppler

Abstract

Acute heart failure (AHF) is defined by the presence of symptoms of heart failure (at rest or during exercise) in conjunction with objective evidence of cardiac dysfunction (1). It may correspond to either a new-onset heart failure or a decompensation of chronic heart failure. Symptoms of AHF may predominantly reflect the decrease in cardiac output and associated peripheral hypoperfusion (e.g., fatigue, cardiogenic shock), the pulmonary congestion (e.g., breathlessness, pulmonary edema), or the peripheral congestion (e.g., hepatomegaly, peripheral edema, raised venous pressure) (Fig. 39.1). With the exception of mitral stenosis, pulmonary congestion usually develops secondary to a diastolic dysfunction of the left ventricle (LV) with elevated filling pressure, whereas peripheral hypoperfusion predominantly reflects LV systolic dysfunction. Other clinical presentations of AHF include hypertensive AHF, pulmonary edema, cardiogenic shock, high output failure, and right heart failure (1).