Heart failure vs. decompensated heart failure

[Basch]

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What is the difference between a "normal" heart failure and an acute decompensated heart failure? Lets say, for instance, that a patient with a known but controlled heart failure slowly, within weeks, gets worse, but not life threatening. What would you call that? Is that a "decompensated" heart failure?

Would be thankful for your help!

 

[Siverhideo1985]

Not sure if this is the right way to think about it but I always looked at decompensated heart failure a problem of fluids...when you are in compensated heart failure your fluid balance is even...in = out...no problem. If you become decompensated fluid starts to collect places it shouldn't...lungs...liver...and you have too little fluid other places (like perfusion of kidneys, brain, etc)

Whenever this balance is thrown out of whack and you get the physiological/clinical effects of these fluid imbalances, that's when it is decomensated...this can happen over weeks (person isn't fine-tuned on their water pills) or acutely (MI on top of already week heart)

Hope this helps...

 

[jerseytrash]

What is the difference between a "normal" heart failure and an acute decompensated heart failure? Lets say, for instance, that a patient with a known but controlled heart failure slowly, within weeks, gets worse, but not life threatening. What would you call that? Is that a "decompensated" heart failure?

Would be thankful for your help!

An acute decompensation is a very specific event characterized by typical symptoms relating to systolic heart failure - namely, dyspnea, worsening fatigue, and edema (usually bilateral LE or anasarca). This requires emergency treatment and often admission to an ICU if it's bad enough (although certainly not very often). The main point is that the symptoms all derive from an inability to keep fluid from backing up into the right heart/lungs and venous system - hence the danger of cardiogenic pulmonary edema, anasarca, JVD, etc. Typically controlled heart failure patients are either euvolemic or have some hypervolemia without symptoms.

If someone has worsening heart failure over a period of time without any known precipitating cause and is not getting better, I'd say that patient is developing end-stage heart failure and needs evaluation for placement of an LVAD/heart transplant.

 

[Rendar5]

Please just realize that just because you're in decompensated heart failure, it does not mean that you're hypervolemic. it's a matter of fluid being in the wrong areas, not necessarily too much fluid total. As mentioned above, you can be euvolemic (especially those who come in with acute pulmonary edema)

 

[jerseytrash]

Please just realize that just because you're in decompensated heart failure, it does not mean that you're hypervolemic. it's a matter of fluid being in the wrong areas, not necessarily too much fluid total. As mentioned above, you can be euvolemic (especially those who come in with acute pulmonary edema)

Thanks for the clarification. I think I equated hypervolemia = fluid third spacing which isn't necessarily true

 

[45408]

It's usually an acute deterioration in clinical status, often triggered by some other event/illness or failure to take your meds.