Heart failure

Heart failure
the clinical syndrome that Heart failure describes develops when the heart cannot maintain adequate output, or can do so only at the expense of elevated ventricular
filling pressure.

In mild to moderate forms of heart failure, cardiac output is normal at rest and only becomes impaired when the metabolic demand increases during exercise or some other form of stress.

In practice, heart failure may be diagnosed when a patient with significant heart disease develops the signs or symptoms of a low cardiac output, pulmonary congestion or system venous congestion

Acute left heart failure

Acute de novo left ventricular failure resents with a sudden onset of dyspnoea at rest that rapidly progresses to acute respiratory distress, orthopnoea and prostration. The precipitant, such as acute MI, is often
apparent from the history.

The patient appears agitated,
pale and clammy.
The peripheries are cool to the touch and the pulse is rapid.
Inappropriate bradycardia or excessive tachycardia
should be identified promptly
as this may be the precipitant for the acute episode of heart failure.
The BP is usually high because of sympathetic nervous system activation, but may be normal or low if the patient is in cardiogenic shock