Acute heart failure and cardiogenic shock: modern principles of diagnosis and treatment

M.O. Harbar, H.V. Svitlyk, Ya.M. Pidhirnyy, Yu.O. Svitlyk


Acute heart failure is life-threatening medical condition that requires urgent evaluation and optimal treatment. The article considers the modern point of view on acute heart failure according to the European Society of Cardiology Guidelines on the treatment of heart failure (2016), acute myocardial infarction in patients with ST elevation (2017) and acute myocardial infarction in patients without persistent ST elevation (2015). The article describes the main underlying precipitants and causes of acute heart failure onset (both cardiac and non-cardiac). Attention is paid to different classification approaches based on various criteria — triggering factors (leading to decompensation), level of blood pressure, clinical profile of a person, T. Killip and J. Kimball classification in case of acute coronary syndrome. Clinical classification is modern and is based on bedside physical examination of a patient in order to detect signs of peripheral hypoperfusion and/or congestion that allow identifying four clinical groups and starting appropriate initial treatment. Since the specificity and sensitivity of clinical findings are often not sa­tisfactory, there are additional investigations — instrumental and laboratory tests; their diagnostic role, advisability, and time of conduction are considered. Criteria for hospitalization in intensive care unit are given. Also recommendations for the management of early phase with oxygen supply and ventilator support are described. Attention is focused on non-invasive positive pressure ventilation (continuous positive airway pressure and bilevel positive airway pressure) in patients with respiratory distress syndrome that should be started as soon as possible to reduce the rate of endotracheal intubation. Pharmacotherapy of acute heart failure is described, including peculiarities of vasodilators, vasopressors and inotropic agent administration. Early reperfusion strategy and implementation of device therapy (renal replacement therapy, mechanical assist devices) were stressed.


acute heart failure; cardiogenic shock; classification; diagnostic algorhythm; treatment


Клінічні рекомендації з діагностики та лікування гострої серцевої недостатності / О.М. Пархоменко, К.М. Амосова, Г.В. Дзяк та ін. // [Електронний ресурс]. Режим доступу:

Thirty-year trends (1975 to 2005) in the magnitude of and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective / R.J. Goldberg, F.A. Spencer, J.M. Gore et al. // Circulation. — 2009. — № 119. — Р. 1211-1219.

Reynolds H.R. Cardiogenic shock: Current concepts and improving outcomes / H.R. Reynolds, J.S. Hochman // Circulation. — 2008. — № 117. — Р. 687-697. — DOI: 10.1161/CIRCULATIONAHA.106.613596.

Predictionof risk of death and myocardial infarction in the six months after presentation withacute coronary syndrome: prospective multinational observational study (GRACE) / K.A. Fox, O.H. Dabbous, R.J. Goldberg et al. // British Medical Journal. — 2006. — № 333. — Р. 1091-1099.

Roger V.L. Epidemiology of heart failure // Circulation Research. — 2013. — № 113. — Р. 646-659.

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) / P. Ponikowski, A.A. Voors, S.D. Ankeret et al. // European Heart Journal. — 2016. — Vol. 37, Issue 27. — Р. 2129-2200;

Acute Myocardial Infarction in patients presenting with ST-segment elevation (Management of). 2017 ESC Clinical Practice Guidelines [Електронний ресурс]. — Режим доступу:

2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation / M. Roffi, C. Patrono, J.-P. Collet et al. // European Heart Journal. — 2016. — Vol. 37, Issue 3. — Р. 267-315.

Уніфікований клінічний протокол екстреної, первинної, вторинної (спеціалізованої), третинної (високоспеціалізованої) медичної допомоги та медичної реабілітації. Гострий коронарний синдром без елевації сегмента ST / В.В. Кравченко, М.Ю. Соколов, Т.В. Талаєва та ін. [Електронний ресурс]. — Режим доступу:

Thomas S.S. Hemodynamic classifications of acute heart failure and their clinical application / S.S. Thomas, A. Nohria // Circulation Journal. — 2012. — № 76. — Р. 278-286.

Killip T. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients / T. Killip, J.T. Kimball // American Journal of Cardiology. — 1967. — № 20(4). — Р. 457-464.

Prognostic Importance of Physical Examination for Heart Failure in Non–ST-Elevation Acute Coronary Syndromes. The Enduring Value of Killip сlassification / U. Khot, G. Jia, D.J. Moliternoуе et al. // Journal of the American Medical Association. — 2003. — Vol. 290. — Р. 2174-2181.

Validation of the Killip-Kimball Classification and Late Mortality after Acute Myocardial Infarction / B.H. Gallindo de Mello, G.B.F. Oliveira, R.F. Ramos et al. // Arquios Brasileiros de Cardiologia. — 2014. — № 103 (2). — Р. 107-117.

Does this dyspneic patientin the emergency department have congestive heart failure? / C.S. Wang, J.M. FitzGerald, M. Schulzer et al. // JAMA. — 2005. — № 294. — Р. 1944-1956.

Lichtenstein D. Novel approaches to ultrasonography of the lung and pleural space: where are we now? / Lichtenstein D. // Breathe. — 2017. — Vol. 13, № 2. — Р. 100-111.

Recommendations on pre-hospital and earlyhospital management of acute heart failure: a consensus paper from the HFA ofthe ESC, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine / A. Mebazaa, M.B. Yilmaz, P. Levy // European Journal of Heart Failure. — 2015. — Vol. 17. — Р. 544-558.

Potentially detrimental cardiovascular effects of oxygen in patients with chronic left ventricular systolic dysfunction / J.H. Park, S. Balmain, C. Berry et al. // Heart. — 2010. — Vol. 96. — Р. 533-538.

Vital F.M. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema / Vital F.M.R., Ladeira M.T., Atallah A.N. // Cochrane Database Syst. Rev. — 2013. — 5. — CD005351.

Meta-analysis: noninvasive ventilation in acute cardiogenic pulmonary edema / C.L. Weng, Y.T. Zhao, Q.H. Liuet et al. // Annals of Internal Medicine. — 2010. — Vol. 152(9). — Р. 590-600.

2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) / S. Windecker, P. Kolh, F. Alfonso et al. // European Heart Journal. — 2014. — Vol. 35(37). — Р. 2541-2619.

Gong B. Levosimendan treatment for heart failure: a systematicreview and meta-analysis / B. Gong, Z. Li, P.C. Yat Wong // Journal of Cardiothorac Vascular Anesthesiology. — 2015. — Vol. 29. — Р. 1415-1425.

Milrinone for the treatment of acuteheart failure after acute myocardial infarction: a systematic review and meta-analysis / X. Tang, P. Liu, R. Li et al. // Basic and Clinical Pharmaco­logy and Toxicology. — 2015. — № 117. — Р. 186-194.

Sunu S.T. Hemodynamic classification of acute heart failure and their clinical application / S.T. Sunu, N. Anju // Circulation Journal. — 2012. — Vol. 76. — Р. 278-286.

Comparison of dopamine and norepinephrine in the treatment of shock / D. De Backer, P. Biston, J. Devriendt et al. // New English Journal of Medicine. — 2010. — № 362. — Р. 779-789.

European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary / K.G. Monsieurs, J.P. Nolan, L.L. Bossaert et al. // Resuscitation. — 2015. — № 95. — Р. 1-80.

Use of intravenous morphine for acute decompensated heart failure in patients with and without acute coronary syndromes / Z. Iakobishvili, E. Cohen, M. Garty et al. //Acute Cardiac. Care. — 2011. — № 13(2). — Р. 76-80.

Peacock W.F., Hollander J.E., Diercks D.B., Lopatin M., Fonarow G., Emerman C.L. Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis // Emerg. Med. J. — 2008. — № 25(4). — Р. 205-209.

The use of echocardiography in acute cardiovascular care: Recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association / P. Lancellotti, S. Price, T. Edvardsen et al. // European Heart Journal of Acute Cardiovascular Care. — 2015. — № 4(1). — Р. 3-5.

Keeley E.C. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials / E.C. Keeley, J.A. Boura, C.L. Grines // Lancet. — 2003. — № 361(9351). — Р. 13-20.

Effect of an invasive strategy on in-hospital outcome in elderly patients with non-ST-elevation myocardial infarction / T. Bauer, O. Koeth, C. Junger et al. // European Heart Journal. — 2007. — Vol. 28. — Р. 2873-2878.

Comparison of dopamine and norepinephrine in the treatment of shock / D. De Backer, P. Biston, J. Devriendt et al. // New English Journal of Medicine. — 2010. — № 362(9). — Р. 779-789.

Intra-aortic balloon counterpulsation and infarct size in patients with acute anterior myocardial infarction without shock: the CRISP AMI randomized trial / M.R. Patel, R.W. Smalling, H. Thiele et al. // Journal of American Medical Assosiation. — 2011. — № 306(12). — Р. 1329-1337.

Intraaortic balloon supportfor myocardial infarction with cardiogenic shock / H. Thiele, U. Zeymer, F.J. Neumann et al. // New England Journal of Medicine. — 2012. — № 367. — Р. 1287-1296.

Intra-aortic balloon counterpulsation in the treatment ofinfarction-related cardiogenic shock-review of the current evidence / M. Buerke, R. Prondzinsky, H. Lemm et al. // Artificiate Organs. — 2012. — № 36. — Р. 505-511. — doi: 10.1111/j.1525-1594.2011.01408.x.

Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials / J.M. Cheng, C.A. den Uil, S.E. Hoeks // European Heart Journal. — 2009. — № 30(17). — Р. 2102-2108.

2014 ESC/European Association for Cardio-Thoracic Surgery guidelines on myocardial revascularization / S. Win­decker, P. Kolh, F. Alfonso et al. // European Heart Journal. — 2014. — V. 35(37). — Р. 2541-2619;



  • There are currently no refbacks.

Copyright (c) 2018 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2018


   Seo анализ сайта