Acute Decompensated Heart Failure

• Shortness of breath (Dyspnoea): Difficulty breathing, especially during physical activities.
• Orthopnoea: Difficulty breathing when lying down.
• Fluid retention: Swelling in the legs, abdomen, or other parts of the body due to fluid build-up.
• Fatigue and weakness: Feeling tired and lacking energy, even with minimal physical exertion.
• Rapid or irregular heartbeat: Palpitations, a fast or irregular heartbeat, may be experienced.
• Reduced exercise tolerance: Difficulty in performing usual physical activities or exercising.

ADHF is diagnosed by cardiologists, by integrating various clinical information, including:

• Patient symptoms
  

• Clinical examination findings
  • Signs of heart failure/ fluid retention
• Laboratory tests
  • Natriuretic peptics (such as NT-proBNP): Protein hormones produced by the heart in response to the ‘stress level’ of the heart muscles. This protein is markedly elevated in ADHF.
• Electrocardiogram (ECG)
  • Electrical tracing of the heart, looking for evidence of acute myocardial infarction.
• Chest radiograph
  • X-ray of the chest to examine for abnormal heart enlargement/ abnormal fluid collection in the lungs
• Echocardiogram
  • An echocardiogram is an ultrasound examination where the sound waves create a graphic outline of the heartbeats. It shows the size and structure of the heart and heart valves and blood flow through the heart, helping to evaluate the pumping action of the heart. 
  • You should feel no major discomfort during the examination. You may feel a coolness on your skin from the gel on the sound-wave transducer (ultrasound wand). You may also feel a slight pressure of the sound-wave transducer against your chest. 
  • Generally, this is a safe and common examination, however, kindly inform the medical professional if you may be allergic to the gel used.
• Cardiovascular magnetic resonance imaging (MRI)
  • Detailed imaging of the heart using a magnetic field and radio waves. This involves putting a patient through a magnetic ‘tunnel’ and obtaining images of the heart by manipulation of magnetic waves. It is done to assess heart structure, function, and blood flow, and has good resolution to examine for heart muscle diseases. This exmination does not hurt but some may find it to be claustrophobic. It is also generally safe; rare risks include allergic reactions to the contrast dye used in the test.

• Invasive tests
  • Coronary angiogram: Examine for presence of blood vessel blockages which can account for the sudden weakening of the heart.
  • Cardiac catheterisation: The threading of a thin catheter from peripheral blood vessels into the right heart chambers (‘right heart catheterisation’) or coronary arteries (‘left heart catheterisation’/ coronary angiogram), allowing us to understand the heart function and look for blood vessel blockages. It is done to assess pressures within the heart chambers, assess heart function and identify potential blockages in blood vessels. Local anaethesia is used during the procedure and there might be mild discomfort. Potential risks and complications are rare but may include bleeding or damage to blood vessels and heart structures.

Immediate diagnosis of this condition and prompt treatment can prevent progressive worsening, thus improving patient symptoms.

• Medications that relief congestion:
  • Prescription medications designed to manage symptoms and improve heart function. They serve to improve patients' symptoms and prolong patients’ lives. Patients can expect relief from symptoms such as shortness of breath and fluid retention. Improved heart function and reduced strain on the heart.
  • While individual responses may vary, such medications are generally effective in symptom management and improving quality of life. Side effects may include dizziness, kidney dysfunction, electrolyte imbalances, or allergic reactions.
  • Patients are encouraged to adhere to the prescribed medications, regularly monitor their blood pressure and overall health. If experiencing any unexpected or severe medication side effects, worsening symptoms, or any new health concerns, please alert your doctor.
• Device Therapy (e.g., Pacemaker or Defibrillator):
  • This therapy involves the implantation of devices to regulate heart rhythm and prevent sudden cardiac arrest.
  • A day-surgery procedure will be necessary to implant such an electronic device and such devices are effective in managing heart rhythm disorders. While this procedure is generally safe and effective, there is a small risk of complications including infection, surgical risks, or device malfunction.
  • Patients are strongly encouraged to regularly attend follow-up appointments for device checks and to monitor for any signs of infection or device-related issues. If experiencing symptoms of infection (such as redness, swelling, or fever) or if there are concerns about the device's functionality, please alert your doctor.

At the National University Heart Centre, Singapore (NUHCS), a multi-disciplinary Heart Failure Team is available for the prompt diagnosis and treatment of patients with ADHF. This allows for rapid improvement of patients' symptoms and reduces the need for prolonged hospital stay.