What is acute heart failure?

Written by Liu Ying
Cardiology
Updated on June 19, 2025
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Acute heart failure refers to an acute episode or exacerbation of heart failure, presenting as acute cardiac insufficiency or acute decompensation of chronic heart failure. Acute heart failure can be divided into acute left heart failure and acute right heart failure. Diseases that can cause acute left heart failure include acute coronary syndrome, hypertensive emergency, acute severe myocarditis, etc. Diseases that can lead to acute right heart failure include right ventricular infarction, acute massive pulmonary embolism, and so on. Patients with acute heart failure may present with sudden severe breathing difficulties, accompanied by frequent coughing, coughing up pink frothy sputum, etc. In severe cases, patients may exhibit confusion among other symptoms. Treatment should be aggressive to improve prognosis, such as administering oxygen, diuretics, sedation with morphine, vasodilators, etc. Specific treatment plans should be determined by a specialist based on the cause of the acute heart failure. (Specific medication use should be guided by a doctor; do not self-medicate.)

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Written by Wang Li Bing
Intensive Care Medicine Department
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Is the heart rate fast or slow in heart failure?

Heart failure is also relatively common in clinical practice, primarily due to dysfunction in the heart's contractile or relaxation capabilities. This leads to ineffective expulsion of venous blood returning to the heart, resulting in venous congestion and a series of symptoms. Patients typically experience varying degrees of breathing difficulty, coughing, expectoration, coughing up pink frothy sputum, as well as gastrointestinal symptoms. Following the onset of heart failure, a patient's heart rate generally increases as a compensatory response to promote increased cardiac output. If a patient enters the terminal stage of heart failure, a decrease in heart rate may occur, and can even lead to death.

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Written by Zhang Yue Mei
Cardiology
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What causes acute heart failure?

Acute heart failure can occur in diseases of the heart itself, as well as in other serious diseases that lead to heart failure. Common cardiac diseases include severe arrhythmias, cardiomyopathy, and myocardial infarction. If these diseases are not well treated, they can cause acute heart failure. Other diseases can be seen in cases such as drug poisoning, severe anemia, severe infection, and during the treatment of other diseases when excessive use of fluids increases the burden on the heart, leading to acute heart failure.

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Written by Zhang Yue Mei
Cardiology
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Heart Failure Drug Therapy

Due to some myocardial diseases that cause damage to the myocardium, or other reasons that increase the heart's load, heart failure may occur. Clinical treatment involves strengthening the heart and promoting diuresis, improving blood vessel function, increasing the heart’s contractility, reducing the heart’s resistance, and decreasing the volume of blood returning to the heart. Through these effective drug treatments, heart failure can be corrected. Patients with heart failure should avoid excessive fatigue and maintain a low-salt diet to prevent increasing the burden on the heart.

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Written by Zhou Yan
Geriatrics
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Compensatory mechanisms of acute heart failure

There are several compensatory methods for acute heart failure. The first is mechanical ventilation, including non-invasive mechanical ventilation and tracheal intubation. Mechanical ventilation is commonly referred to as assisted breathing with a ventilator. The second is continuous renal replacement therapy, commonly known as total ultrafiltration, which can be used to remove excess fluid and metabolic waste from the body. The third is intra-aortic balloon counterpulsation, which can effectively improve myocardial perfusion, reduce myocardial oxygen consumption, and increase cardiac output. The fourth is extracorporeal membrane oxygenation, commonly known as ECMO, which provides external cardiopulmonary support when the heart cannot maintain systemic perfusion or when the kidneys cannot adequately exchange gases. The fifth is the implantable left ventricular assist device, which can maintain peripheral perfusion during acute heart failure and reduce myocardial oxygen consumption, thus reducing cardiac injury. These five methods can provide compensatory treatment when drug therapy is ineffective for patients with acute heart failure.

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Written by Zhou Yan
Geriatrics
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Can acute heart failure be cured?

Acute heart failure refers to the acute onset or exacerbation of a clinical syndrome of heart failure, manifested as either acute onset of new heart failure or acute worsening of chronic heart failure. The goal of treatment is to improve symptoms, stabilize hemodynamic status, protect vital organ functions, improve prognosis, and prevent recurrence. Because the ischemia and hypoxia during an acute heart failure episode, along with severe respiratory distress, are life-threatening, urgent intervention is required. However, whether it can be cured depends on the underlying disease. Since the underlying disease is already present, it cannot be completely cured, but clinical symptoms and prognosis can be improved.