What should you know about acute decompensated heart failure?

It needs prompt assessment because oxygen levels, blood pressure, kidney function and circulation may be affected. New breathlessness at rest, inability to lie flat, rapidly increasing swelling, chest discomfort, confusion or fainting should not be watched at home without medical advice.

When the heart cannot move blood effectively enough for the body's needs, pressure can rise behind it. Fluid may then collect in the lungs, legs or abdomen. This can produce breathlessness, cough, swollen ankles, fatigue, reduced appetite or a sudden need to sleep propped upright.

Possible triggers include a heart rhythm problem, heart attack, infection, uncontrolled blood pressure, changes in kidney function, missed medicines, or excess salt or fluid for that person's plan. Some medicines can also aggravate fluid retention. Identifying the trigger helps clinicians choose treatment and reduce the chance of another episode.

Sit upright if lying flat worsens breathing and contact the heart-failure team or urgent-care service. Take regular medicines as prescribed unless a clinician gives different instructions. Do not double a missed dose, take extra diuretic tablets or borrow oxygen without a personalised plan. Keep the medication list, recent weight record and information about fluid intake available.

The medical team may check oxygen levels, heart rhythm, blood pressure and signs of congestion. Blood tests can assess kidney function and salts, while heart tracing and imaging may help identify a trigger. Treatment can include oxygen when levels are low, medicines to remove excess fluid, and therapy for infection, rhythm disturbance or another underlying cause.

Call local emergency services for severe breathlessness at rest, gasping, blue or grey lips, frothy sputum, crushing or persistent chest pain, collapse, new confusion or extreme drowsiness. Sudden weakness, facial droop or speech difficulty also needs an emergency response because these are stroke signs.

Seek urgent same-day advice for breathlessness that is clearly increasing, new difficulty sleeping flat, reduced urine, worsening leg or abdominal swelling, dizziness, or palpitations accompanied by weakness. The urgency comes from the symptoms and their change from baseline. Do not delay because a routine review is already booked.

Ask what triggered the episode, whether heart or kidney function changed, and which medicine doses now apply. Request clear limits for salt and fluid that fit the individual condition, plus a written response plan for weight, swelling or breathlessness changes. Confirm the next heart-failure review and whether rhythm, blood-pressure or medication monitoring is needed.