Acute on chronic systolic heart failure explained

The resulting fluid build-up or reduced blood flow may cause worsening breathlessness, swelling, fatigue, cough or confusion. Medical assessment should identify both the severity of the flare and the reason it happened.

In systolic heart failure, the main pumping chamber does not contract strongly enough. During an acute deterioration, pressure can build behind the heart and push fluid into the lungs, legs or abdomen. If forward blood flow falls, the kidneys, brain and other organs may receive less circulation.

Possible triggers include infection, a heart rhythm disturbance, uncontrolled blood pressure, reduced blood supply to the heart, kidney problems, excess salt or fluid, and missed or recently changed medication. Tests may include an electrocardiogram, blood tests, chest imaging and an ultrasound assessment of the heart.

Follow the urgent treatment plan provided by the assessing team. Care often focuses on relieving congestion, supporting oxygenation when needed and correcting the precipitating problem. Do not stop beta blockers, blood-pressure treatment or other heart medicines abruptly unless the treating clinician instructs you to.

Once home, take each medicine at the stated time and keep laboratory and clinic appointments. Use any symptom or weight diary your team recommends, follow your individual salt and fluid guidance, and report a steady decline in activity tolerance. Avoid anti-inflammatory painkillers unless a clinician who knows your heart and kidney status approves them.

Request emergency help for intense breathlessness, gasping, blue or grey colour around the lips, fainting, severe chest pressure, sudden confusion, cold clammy skin with profound weakness, or coughing pink frothy fluid. Sit upright if that makes breathing easier while help is coming.

Contact your clinical team the same day for rapidly increasing leg or abdominal swelling, breathlessness that newly limits routine tasks, repeated waking because you cannot breathe lying flat, palpitations with light-headedness, or markedly reduced urine. Prompt treatment may prevent further congestion and organ strain.

Ask whether the heart's pumping function has changed, what caused this episode, and whether each medicine should continue at the same dose. Clarify which symptoms require a same-day call, what blood tests need monitoring, how physical activity should restart, and whether an irregular rhythm or high blood pressure needs additional treatment.