[Acute heart failure and cardiogenic shock : An update]

Area of Science:

• Cardiology
• Internal Medicine

Context:

• Acute heart failure is a complex syndrome characterized by elevated intracardiac pressures and systemic venous congestion.
• Patients may present with de novo heart failure or acute decompensation of pre-existing cardiac conditions.
• The heterogeneous patient population presents diverse underlying cardiac pathologies leading to acute heart failure.

Purpose:

• To outline the pathophysiology of acute heart failure, including ventricular dysfunction, increased preload/afterload, and resulting hypoperfusion and congestion.
• To describe current therapeutic strategies focused on addressing cardiac dysfunction, volume overload, and hemodynamic instability.
• To highlight the persistent challenge of high mortality rates despite recent therapeutic advancements.

Summary:

• Ventricular dysfunction in acute heart failure leads to increased preload and afterload, causing decreased perfusion (forward failure) and systemic congestion (backward failure).
• This can progress to impaired end-organ function or cardiogenic shock, where organ perfusion is insufficient.
• Therapeutic goals include correcting cardiac dysfunction, reducing volume overload, and stabilizing circulation.

Impact:

• Acute heart failure significantly impairs end-organ function and can lead to life-threatening cardiogenic shock.
• Despite advances, randomized trial data for acute heart failure is less robust than for chronic forms.
• The 1-year mortality rate for acute heart failure remains approximately 20-30%, underscoring the need for improved management strategies.