Internal Medicine

0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45

Acute Fatty Liver of Pregnancy Acute Heart Failure 23

complications and prognosis

■Acute hepatic failure, with ascites, renal failure, GI bleeding, pro-

longed jaundice

■Nephrogenic diabetes insipidus may occur

Acute Heart Failure....................................

JOHN R. TEERLINK, MD

history & physical

[see also Gheorghiade M, et al. Acute heart failure syndromes: Current

state and framework for future research.Circulation2005;112:3958–

68; Niemenen MS, et al. Executive summary of the guidelines on the

diagnosis and treatment of acute heart failure.Eur Heart J2005;26:384–

416.]

History

■>1 million hospitalizations for heart failure per year in US alone

■Acute heart failure (AHF): catastrophic loss of cardiac function (loss

of myocyte function: ischemia/ infarction, inflammation, edema,

trauma, post-cardiac bypass, alcohol binge or other toxic substance

use/ exposure; structural: papillary muscle rupture, VSD)

➣Rapid onset of symptoms

➣Preceding viral illness

➣Angina or anginal equivalent

■Acute heart failure syndrome (AHFS): gradual or rapid change in

heart failure signs and symptoms resulting in a need for urgent

therapy. Approximately 30–60% of patients will have normal systolic

function.

➣Preceding viral illness

➣Angina or anginal equivalent

➣Prior myocardial infarction or systolic dysfunction

➣Hypertension or other restrictive cardiomyopathy

➣Progressive increase in weight, peripheral edema, bloating, dys-

pnea

➣Relatively gradual onset of symptoms

■AHFS clinical presentations

➣Acute decompensated heart failure, de novo or decompensation

of chronic heart failure (40–50% of patients)

➣Hypertensive acute heart failure (40–50%)

➣Pulmonary edema (3%)