Decompensated Heart Failure

Decompensated heart failure, also called acute decompensated heart failure (ADHF), occurs mostly in people with preexisting heart failure, although some cases are patients newly diagnosed with heart failure. ADHF means that the heart’s ability to pump blood is worsening. The heart is essentially a pump that needs to keep blood flowing smoothly throughout the body. When this pump starts to fail, it leads to heart failure.¹

ADHF is one of the main reasons for emergency room visits and hospital admissions. ADHF increases the risk for health issues down the road and even death.^1-3

What is the difference between compensated and decompensated heart failure?

If the body can adjust and manage the heart’s reduced pumping ability, it is called compensated heart failure. With compensated heart failure, the heart is still struggling to pump blood effectively, but the body has found ways to cope. Symptoms may be mild, easily manageable, or not noticeable at all because the body is compensating for the heart’s reduced function.¹

Decompensated heart failure, on the other hand, is when the body’s coping mechanisms are no longer enough. Symptoms are more severe, and it becomes clear that the heart is struggling. The worsening of symptoms may be gradual or sudden. This is often a medical emergency that needs immediate attention.¹

What causes decompensated heart failure?

ADHF typically affects older adults with preexisting medical conditions. There are several possible causes of ADHF. They include:^1-3

• History of heart failure – Those who already have chronic heart failure are more at risk for ADHF.
• Heart attacks – Damage from a heart attack can weaken the heart muscle.
• Infections – Severe infections can put stress on the heart.
• Heart valve problems – Issues with the valves in the heart can affect blood flow.
• Arrhythmias – Irregular heartbeats can impair the heart’s ability to pump efficiently.
• High blood pressure – Uncontrolled high blood pressure can strain the heart over time.
• Comorbidities – Other health conditions like type 2 diabetes, heart disease, chronic kidney disease, and chronic obstructive pulmonary disorder (COPD) can increase the risk of ADHF.
• Lifestyle factors – Poor diet, lack of exercise, too much alcohol, and smoking can all contribute to heart failure or reduce the body’s ability to cope with heart failure.

What are the symptoms of decompensated heart failure?

Recognizing the symptoms of decompensated heart failure can make the difference between life and death. Symptoms may include:^1-3

• Difficulty breathing during exercise (dyspnea)
• Difficulty breathing while lying down (orthopnea)
• Swelling in the legs, ankles, and feet (edema)
• Heart palpitations
• Fatigue
• Chest pain
• Abdominal bloating
• Weight gain

If you or a loved one is having any of these symptoms, seek medical help immediately.

How is decompensated heart failure diagnosed?

Diagnosing ADHF involves several steps:³

• Medical history and physical exam – Your doctor will ask about your symptoms, take your medical history, and perform a physical exam.
• Blood tests – These tests can reveal signs of heart failure or an infection. They also can help rule out other conditions.
• Imaging tests – An echocardiogram (ultrasound of the heart) and chest radiograph can show the heart’s size and shape, and how well it is functioning. A lung ultrasound may also be performed.
• Electrocardiogram (ECG or EKG) – This test records the electrical activity of the heart and detects any problems.
• Stress tests – These measure how well the heart performs under physical stress.

What are the treatment options for decompensated heart failure?

The goals of ADHF treatment are to:^1,4

• Improve symptoms
• Manage underlying medical conditions
• Preserve kidney function
• Prevent further heart damage

Treating ADHF involves a combination of lifestyle changes, medicine, and sometimes surgery and/or medical devices.^1,4

Lifestyle changes

The following lifestyle changes can reduce a person’s risk for decompensated heart failure:⁴

• Eating a healthy, low-salt diet
• Exercising regularly
• Maintaining a healthy weight
• Cutting back on alcohol
• Quitting smoking

Medicines

The following types of medicine may be prescribed to treat ADHF:^1,4

• Diuretics (water pills) – reduce fluid buildup in the body
• Vasodilators – relax blood vessels and help improve blood flow
• Calcitropes – change the level of calcium inside cells to improve how the heart muscle contracts and pumps blood
• Beta-blockers – lower blood pressure by reducing how frequently the heart beats

Surgery and/or mechanical assistance

In some cases, more intervention is needed to treat ADHF. For people with severe ADHF, mechanical support may be necessary. Certain devices help the heart pump and are considered a “bridge to recovery.” An example is a left ventricular assist device, or LVAD.⁴

Talk to your doctor

Decompensated heart failure is a serious condition. But with the right treatment and lifestyle changes, many people can manage their symptoms and improve their quality of life. If you think you have heart failure, talk to your doctor to get a treatment plan in place.^1,4