Chronic stable heart failure may easily decompensate. This most commonly results from an intercurrent illness (such as pneumonia), myocardial infarction (a heart attack), abnormal heart rhythms (such as atrial fibrillation), uncontrolled high blood pressure, or the person's failure to maintain a fluid restriction, diet, or medication.[3] Other well recognized precipitating factors include anemia and hyperthyroidism which place additional strain on the heart muscle. Excessive fluid or salt intake, and medication that causes fluid retention such as NSAIDs and thiazolidinediones, may also precipitate decompensation.[4]
Acute myocardial infarction can precipitate acute decompensated heart failure and will necessitate emergent revascularization with thrombolytics, percutaneous coronary intervention, or coronary artery bypass graft.
A jugular venous distension is the most sensitive clinical sign for acute decompensation.[5]
Difficulty breathing, a cardinal symptom of left ventricular failure, may manifest with progressively increasing severity as the following:
Difficulty breathing with physical activity (exertional dyspnea)&Difficulty breathing while lying flat (orthopnea)&Episodes of waking up from sleep gasping for air (paroxysmal nocturnal dyspnea)&Acute pulmonary edem
Other cardiac symptoms of heart failure include chest pain/pressure and palpitations. Common noncardiac signs and symptoms of heart failure include loss of appetite, nausea, weight loss, bloating, fatigue, weakness, low urine output, waking up at night to urinate, and cerebral symptoms of varying severity, ranging from anxiety to memory impairment and confusion.[2]