Acute heart failure, cardiogenic shock

1. Big picture

Acute heart failure (AHF) is a rapid onset or worsening of heart failure symptoms/signs requiring urgent treatment. It ranges from hypertensive pulmonary edema with preserved blood pressure to cardiogenic shock with tissue hypoperfusion and multiorgan failure.

For the exam, think:

Acute dyspnea + crackles/edema → acute heart failure
Acute heart failure + hypotension/hypoperfusion → cardiogenic shock
Cardiogenic shock after chest pain/STEMI → urgent coronary reperfusion

The practical emergency logic is:

Airway → Breathing → Circulation
↓
Oxygenation/ventilation
↓
Blood pressure and perfusion
↓
Congestion relief
↓
Find and treat the trigger

Current guideline-based heart failure management emphasizes early recognition, practical evidence-based treatment, and referral for advanced HF therapy when needed. The ESC guideline page also notes that the 2021 acute/chronic HF guideline has a 2023 focused update. ([European Society of Cardiology][1])

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