Differential Diagnosis

of Acute Heart Failure

 Pulmonary
Disorders

C
O
M
M
O
N

Cardiac Disorders
Causing (Other)
Shortness
of breath
 Acute Exacerbation of Chronic Obstructive
Pulmonary Disease (AECOPD)

Pneumonia

Pulmonary embolism

Pulmonary
Pneumothorax
dissorder,
There are :
Acute respiratory distress syndrome

Redistributive/hypovolemic shock
 Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)

Definition & Etiology : Clinical Sign :

 There may be increased expiratory
 (AECOPD)  a clinical diagnosis made
wheezes and rhonchi 
when a patient with COPD experiences a impending respiratory failure.
sustained increase in cough, sputum
 Cough may become more severe
production, and/or dyspnea.
and strenuous
 Bacterial infections are implicated in
 Sputum volume may increase,
the majority of AECOPD episodes.
and the color of the sputum may
 Sputum and bronchoscopy data have
change from whitish to yellow or
shown that Moraxella catarrhalis, green.
Haemophilus influenza, and
 Central nervous system
Streptococcus pneumonia are the
symptoms may be present,
most common organisms associated
ranging from irritability to
with AECOPD episodes. Other bacteria
decreased responsiveness
(e.g., Pseudomonas and
secondary to worsening
Staphylococcus) have also been
hypoxemia, hypercapnea, or
implicated.
both.
 Pneumonia

Definition & Etiology : Clinical Sign :

 Pneumonia is an inflammation of  High fever and chills
the air sacs in the lungs (alveoli) and  Physical weakness and a
the surrounding tissue.
strong feeling that you are
 Fluid can also collect between the
lungs and the chest wall, which unwell
makes breathing even more  Cough with phlegm (sputum)
difficult.  Shortness of breath and rapid
 Another possible complication is a breathing
lung abscess, the formation of a  Racing pulse
pus-filled space in the lung.
 Pneumonia is usually caused
by bacteria– and most frequently by
bacteria called pneumococci.
Sometimes, other types of bacteria
such as Haemophilus influenzae
or Mycoplasma pneumoniae are
also involved.
 Pulmonary Embolism
Definition & Etiology :
 Pulmonary embolism is a blockage
in one of the pulmonary arteries in
lungs.
 In most cases, pulmonary embolism
is caused by blood clots that travel
to the lungs from deep veins in the
legs or, rarely, from veins in other
parts of the body (deep vein
thrombosis).
Clinical Sign :
 Shortness of breath.
 Chest pain
 Cough
 Rapid or irregular heartbeat
 Lightheadedness or dizziness
 Excessive sweating
 Fever
 Leg pain or swelling, or both,
usually in the calf caused by a deep
vein thrombosis
 Clammy or discolored skin
(cyanosis)
 Pneumothorax

Definition & Etiology : Clinical Sign :

 A pneumothorax is defined as a  Respiratory discomfort

collection of air outside the lung but  Increased respiratory rate
within the pleural cavity.  Tachycardia more than 134 beats
 It occurs when air accumulates per minute
between the parietal and  Hypotension
visceral pleurae inside the chest.  Cyanosis
The air accumulation can apply  Respiratory failure
pressure on the lung and make it  Cardiac arrest
collapse.
 Caused by : Smoking ,
Necrotizing pneumonia,
Bronchogenic carcinoma,
Pleural biopsy, Rib fracture
 Acute Respiratory Distress Syndrome

Definition & Etiology : Clinical Sign :

 Acute respiratory distress  Severe shortness of breath

syndrome (ARDS) occurs when fluid  Labored and unusually rapid
builds up in the tiny, elastic air sacs breathing
(alveoli) in lungs.  Low blood pressure
 The fluid keeps the lungs from  Confusion and extreme
filling with enough air, which means tiredness
less oxygen reaches to the
bloodstream. This deprives our
organs of the oxygen they need to
function.
 Caused by : Sepsis, Inhalation of
harmful substances, Severe
pneumonia
 Redistributive/Hypovolemic Shock

Definition & Etiology : Clinical Sign :

 Hypovolemic shock is a condition of  Headache

inadequate organ perfusion  Fatigue
 The result is a drop in cardiac preload to a  Nausea
critical level and reduced macro- and
 Profuse sweating
microcirculation, with negative
consequences for tissue metabolism and the
 Dizziness
triggering of an inflammatory reaction.  Rapid, shallow breathing
 Caused by : decreased intravascular  Rapid heart rate
volume. Most commonly, this is due to  Confusion
external or internal hemorrhage. Other  Weakness
sources of massive fluid loss include  Weak pulse
diarrhea, cholera, burns, or diffuse
“capillary leakage” that occurs with
pancreatitis
 Endocardium: valve heart disease (aortic valve
stenosis, aortic valve regurgitation, mitral valve
regurgitation, and mitral valve stenosis)

Conduction system :Bradycardia (sick sinus

syndrome, atrioventricular block) and Tachycardia
(atrial fibrillation, supraventricular tachycardia,
ventricular tachycardia)

Cardiac Myocardium  Heart failure : Systolic heart

failure (coronary artery disease [CAD], hypertension,
disorder, alcohol abuse) & Diastolic heart failure
there are : (hypertension, aortic valve stenosis, hypertrophic
cardiomyopathy)

Coronary arteries (ischemia)

Pericardium (tamponade, constrictive

pericarditis)
Reference :

 McMurray JJ et al. Eur Heart J (2012); 33:1787-847. Ponikowski P et

al. Eur J Heart Fail. 2016; 18:891-975.
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645331/
 https://www.ncbi.nlm.nih.gov/books/NBK525774/
 https://www.mayoclinic.org/diseases-conditions/pulmonary-embolis
m/symptoms-causes/syc-20354647#:~:text=Pulmonary%20embolism
%20is%20a%20blockage,body%20(deep%20vein%20thrombosis
)
 https://
www.mayoclinic.org/diseases-conditions/ards/symptoms-causes/syc2
0355576
#:~:text=Overview,oxygen%20they%20need%20to%20function
 https://www.healthline.com/health/hyperventilation
 Ponikowski, P., Voors, A.A., Anker, S.D., et al. Guidelines for the
diagnosis and treatment of acute and chronic heart failure. European
Society of Cardiology.(2016). 37, 2129–2200.