Heart Failure (HF)
Definition: Heart failure is a condition in which the heart is unable
to pump blood effectively to meet the body's needs, leading to
symptoms like shortness of breath, fatigue, and fluid retention.
Acute Left Ventricular Failure (ALVF)
Definition: Acute left ventricular failure is a sudden onset of the
heart's inability to pump blood adequately, specifically from the left
ventricle, leading to pulmonary congestion and reduced systemic
perfusion.
Common Causes of Acute Left Ventricular Failure
1. Ischemic Heart Disease (most common cause): Myocardial
infarction (MI), acute coronary syndrome.
2. Hypertension: Chronic hypertension leading to left ventricular
hypertrophy and diastolic dysfunction.
3. Cardiomyopathies: Dilated, hypertrophic, or restrictive
cardiomyopathy.
4. Valvular Heart Disease: Mitral regurgitation, aortic regurgitation,
or aortic stenosis.
5. Arrhythmias: Tachyarrhythmias (e.g., atrial fibrillation,
ventricular tachycardia).
6. Infections: Myocarditis, endocarditis.
7. Acute Volume Overload: Acute kidney injury, excessive
intravenous fluids.
8. Drug Toxicity: Alcohol, chemotherapy agents like doxorubicin.
Pathophysiology of Acute Left Ventricular Failure
1. Decreased Cardiac Output: Left ventricle’s inability to pump
effectively reduces forward blood flow, causing systemic
hypoperfusion.
2. Pulmonary Congestion: Backlog of blood in the left atrium
increases pulmonary venous pressure, leading to pulmonary edema.
3. Neurohormonal Activation: RAAS activation, sympathetic nervous
system overactivity, and increased BNP and ANP levels.
4. Fluid Retention: Kidneys retain fluid due to reduced renal
perfusion, exacerbating pulmonary congestion and peripheral edema.
Clinical Features of Acute Left Ventricular Failure
1. Pulmonary Symptoms: Dyspnea (shortness of breath), orthopnea,
paroxysmal nocturnal dyspnea, pulmonary edema.
2. Systemic Symptoms: Fatigue, weakness, confusion, hypotension,
shock.
3. Signs of Fluid Overload: Peripheral edema, jugular venous
distension, ascites.
4. Tachycardia and S3 gallop on auscultation, cyanosis in severe
cases.
Management of Acute Left Ventricular Failure
1. Oxygen Therapy: To improve oxygenation and reduce pulmonary
congestion, consider CPAP or BiPAP.
2. Pharmacologic Therapy: Diuretics (e.g., Furosemide), vasodilators
(e.g., Nitroglycerin), inotropes (e.g., Dobutamine, Milrinone), ACE
inhibitors/ARBs, beta-blockers.
3. Address the Underlying Cause: Revascularization for ischemia,
arrhythmia control, valve surgery for severe valvular disease.
4. Mechanical Support: Intra-aortic balloon pump (IABP), LVAD for
refractory cases.
5. Monitoring: Vital signs, urine output, electrolytes, fluid balance.
6. Other Supportive Care: Fluid and sodium restriction, pain control,
and sedation to reduce sympathetic drive.
