Insuficiencia cardíaca aguda y edema agudo de pulmón. Manejo diagnóstico y terapéutico en urgencias

Abstract

Acute heart failure is a complex clinical syndrome. It encompasses different diseases with diverse pathophysiologic mechanisms and clinical presentations that require different therapeutic strategies. What they all have in common is failure in heart pump function that leads to the onset of signs and systems of pulmonary and systemic congestion along with peripheral hypoperfusion. It is a disease with a growing incidence associated with high morbidity and mortality and an elevated social and healthcare cost.There are four fundamental clinical presentations: acute decompensation of chronic heart failure (the most common), acute pulmonary edema, isolated right ventricular failure, and cardiogenic shock. It is important to identify the triggering factor; the following require specific emergency management: acute coronary syndrome, hypertensive emergency, arrhythmias with rapid ventricular response or bradycardias/severe conduction disorders, pulmonary embolism, and acute mechanical causes. The suspected diagnosis is clinical and confirmed through various additional tests such as an electrocardiogram, chest x-ray, complete blood count with natriuretic peptides, and an echocardiogram.Treatment must be started immediately if there is clinical suspicion. According to the presenting symptoms, it will include oxygen therapy, diuretics, vasodilators, inotropics, vasopressors, or even ventilatory or circulatory support.