ABSTRACT
Acute heart failure is a complex clinical syndrome with poor prognosis. Fluid retention and redistribution are the main pathophysiological mechanisms involved, along with myocardial cell loss and impaired ventricular filling. These mechanisms can coexist in the same patient, resulting in aggravation of preexisting heart failure (decompensated heart failure) or in rapid clinical deterioration of previously asymptomatic subjects (de novo heart failure). Cardiogenic shock is the most ominous form of AHF, characterized by low cardiac output that results in end-organ hypoperfusion and dysfunction. Because AHF is a life-threatening condition, it requires prompt diagnosis and management. A thorough clinical evaluation is required to assess severity of HF, confirm diagnosis, and identify precipitating factors. Clinical classification according to the presence of congestion and hypoperfusion provides prognostic information and can guide therapy of patients with acute heart failure. However, it should be supported with information derived from clinically available biomarkers (natriuretic peptides, troponin, renal function, and electrolytes) and other relevant laboratory markers (electro-cardiogram, chest x-ray, cardio-thoracic ultrasound).
