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Heart Failure

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Emergency Department Critical Care

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Abstract

Acute heart failure (AHF) is a frequent emergency department (ED) presentation that consumes tremendous amounts of health-care resources and its prevalence is expected to increase substantially. The classic presentation of AHF is the reduced ejection fraction variety in which patients present with fluid overload and hypertension. The less understood and less frequent presentation is reduced ejection AHF, in which poor ventricular compliance leads to reduced cardiac output and pulmonary hypertension. Initial evaluation and stabilization include ensuring adequate perfusion and oxygenation and include an electrocardiogram to evaluate for myocardial infarction and supplemental oxygen, delivered by noninvasive mechanical ventilation, if needed. Diuresis and afterload reduction remain the mainstay of therapy despite minimal data to support their use. Hypotension is an ominous finding in AHF and requires fluid resuscitation or inotropic support prior to diuresis and afterload reduction. Almost all AHF patients require hospitalization, but early and aggressive intervention in the ED has been shown to reduce length of stay and resource consumption.

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Authors and Affiliations

  1. Department of Emergency Medicine, Department of Surgery, Division of Trauma/Critical Care, VCU Medical Center, Medical College of Virginia Campus, Richmond, VA, USA

    Christopher J. Hogan

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  1. Christopher J. Hogan
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Correspondence to Christopher J. Hogan .

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Editors and Affiliations

  1. College of Medicine, University of Florida Health Science Center, Jacksonville, FL, USA

    Joseph R. Shiber

  2. Resuscitation & Emergency Critical Care, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Scott D. Weingart

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Hogan, C.J. (2020). Heart Failure. In: Shiber, J., Weingart, S. (eds) Emergency Department Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-28794-8_12

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  • DOI: https://doi.org/10.1007/978-3-030-28794-8_12

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