What is acute decompensated heart failure (ADHF)?

Diana Meeks
Diana Meeks on behalf of Sigma Nursing
Family Practitioner

Heart failure is a serious, emergency condition, generally caused by hypertension, heart attack, and coronary heart disease. Heart failure may begin suddenly (acute heart failure) or it may come on gradually (chronic heart failure).

In acute heart failure there may be shortness of breath, severe weakness, the need to sit up to breathe, pain in the chest, chest congestion with much bubbly sputum or coughing. This can happen in a person who was previously well or in someone with diagnosed heart disease.

It’s important to treat acute heart failure seriously. Call for medical help or see your doctor immediately for an accurate diagnosis and treatment. There are medications to treat acute heart failure.

Acute heart failure usually occurs with a sudden deterioration of heart function as a result of a heart attack. It may also occur from sudden valve dysfunction or electrical disturbance.

More commonly, however, acute failure is superimposed on more chronic heart failure which may be insidious until which time it becomes acutely evident.

Joan Haizlip, MSN
Cardiologist (Heart Specialist)

Acute heart failure happens when your heart suddenly stops being able to pump blood effectively. The heart is basically a pump. If the pump fails, or weakens, blood cannot be pumped to the rest of the body and signs and symptoms of heart failure occur:

  • shortness of breath (dyspnea)
  • unable to lie flat (orthopnea)
  • swelling in the feet and legs (edema)
  • confusion
  • fatigue
Linda Rohyans
Cardiac Rehabilitation Specialist

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.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.