What is acute decompensated heart failure (ADHF)?

Heart Failure (HF) is a chronic illness; meaning, you go to sleep with it and you wake up with it.  As a progressive illness, most people may experience the following symptoms:  shortness of breath; inability to lay flat due to difficulty breathing; waking up at night feeling short of breath; coughing; fatigue or tiredness; weight gain; confusion; restlessness; decreased memory; chest discomfort; heart rhythm abnormalities; edema or swelling in the hands, abdomen, legs, ankles or feet; sweating; cool, clammy skin; loss of appetite; and nausea.  By making positive lifestyle behavior changes (adhering to a low-sodium diet, weighing daily, taking all medications as prescribed, keeping all follow-up appointments, recognizing worsening symptoms, and notifying your health care team quickly of worsening symptoms), you will be in a better position to manage your HF symptoms.

When HF is compensated, you are able to function day to day with your HF symptoms.  However, the course of chronic, stable HF may easily “hit a bump in the road” and rapidly worsen or acutely decompensate when extra stress or work is placed upon the heart; your heart becomes over-taxed, much like “over-drawing” from your bank account.  You may experience an episode of Acute Decompensated Heart Failure (ADHF) from a variety of causes or precipitating factors: 1) multiple “co-morbid” conditions, for example, also living with diabetes, kidney failure, or lung disease; 2) physical, emotional, or environmental stress  “on top of” your HF, such as when you come down with the flu, are grieving, or exposed to chemicals; 3) suffer a heart attack; 4) develop an abnormal heart rhythm; 5) uncontrolled or untreated high blood pressure; 6) failure to maintain a fluid restriction, low-sodium diet or medication regimen or failure to keep your follow-up appointments.  

With ADHF, hospitalization is recommended for medications and close monitoring. If positive lifestyle behaviors are not adopted and HF symptoms are not managed, ADHF may lead to many readmissions following the initial hospitalization.  With ADHF, the immediate goal is to re-establish an equilibrium or balance between what your body demands and what your heart is able to supply.  This entails ensuring that you become an active participant in your own health and that you develop and maintain positive, self-care behaviors.