Naeem Asghar.
Precipitating factors leading to acute heart failure.
J Cardiovascular Dis Jan ;9(1):24-30.

Objectives: To identify the precipitating factors among the patients presenting with Acute Heart Failure (AHF). Materials and Methods: This cross sectional survey was conducted at the Department of Cardiology, Punjab Institute of Cardiology, Lahore from November 2008 to April 2009. Cases were selected in the Emergency Department. Patients with renal disease or serum creatinine >2 mg/dl at presentation or any other co-morbid medical illness were excluded from study. Results: Mean age of the study population was 55+6.99 years. There were 105(61.8%) male and 65(38.2%) were female. Diabetes mellitus was present in 91(53.5%). History of heart failure was present in 108(63.5%). Evaluation of precipitating factors of heart failure revealed that acute coronary syndromes were the major cause 48(28.2%) of precipitation of heart failure. More male patients 41(39.04%) had heart failure as compared to 7(10.76%) females. ACS was also the major cause 28(30.7%) of heart failure in diabetic patients. Uncontrolled hypertension 40(23.5%) was the second common cause precipitating heart failure with more female patients 25(38.5%) as compared to males 15(14.3%). Uncontrolled hypertension lead to heart failure in 21(23.07%) diabetics. Non-compliance to drugs lead to heart failure in 34(20%) patients with 23(21.9%) males and 11(16.9%) females and 18(19.7%) diabetics. In acute heart failure patients ACS was more common 26(41.9%) as compared to 22(20.3%) patients in chronic heart failure group. Similarly uncontrolled hypertension was more frequent 24(38.7%) in acute heart failure as compared to 16(14.8%) in chronic heart failure. Non compliance with drugs was more common 33(30.5%) in CHF as compared to 1(1.61%) in AHF group. Similarly Arrhythmias were also common 25(23.1%) in CHF as compared to 5(8.06%) patients in AHF group. Conclusion: ACS is the common precipitating factor of AHF among the patients irrespective of gender, history of diabetes mellitus and history of heart failure. In males ACS, while in females uncontrolled hypertension was the most common precipitating factor of AHF. Young, male, diabetics and patients with history of chronic HF suffered more from AHF. Key Words: Heart failure, chronic heart failure, acute heart failure, acute decompensation of chronic heart failure and de novo heart failure.

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