Up-to-date treatment of acute heart failure based on the ESC 2016 guideline
Semmelweis Egyetem, Városmajor Szív- és Érgyógyászati Klinika, Budapest
Acute heart failure (AHF) is by definition the rapid appearance and progression of circulatory failure that requires urgent hospital admission, evaluation and immediate interventions. It can be new onset or recurrence of symptoms and signs of heart failure. AHF is one of the most common cause of admission to hospital in people older than 65 years. In-hospital mortality of AHF is near 10 % except cardiogenic shock that refers for 40-50% of mortality. AHF exerts specific pathophysiology impairing haemodynamics, renal function, and end-organ function. Most important change in the first line treatment is to assess and treat cardiogenic shock and respiratory failure on a fast and aggressive manner. After stabilisation and relief of symptoms one must do the physical examination that remains important for diagnosis and tailored treatment, focusing particularly on the signs of congestion and hypoperfusion. Characterizing the wet vs dry and cold vs warm clinical presentation the basic urgent therapy can be established to decrease congestion, increase perfusion. The worst case scenario is the wet and cold such as cardiogenic shock patient. Hereby beside inotropes, Ca-sensitizers, vasopressors and even mechanical circulatory support (ECLS, ECMO, VAD) in selected patient population is to be considered. Latter is called bridge therapy in HF. One more important message is given by the new guideline: if the patient with AHF does not represent symptomatic hypotension, bradycardia or cardiogenic shock, he should continue taking β blockers. Discontinuation of β blockers in AHF patients admitted to hospital was associated with significantly increased in-hospital mortality, short-term mortality.