Precipitating or exacerbating factors in heart failure
Regardless of the underlying cause, onset of new heart failure or episodes of acute decompensation in patients with existing heart failure, may be precipitated by factors that require specific therapy. Episodes of acutely decompensated heart failure require investigation to find and treat the precipitating factors.
Precipitating factors include:
- lack of adherence to drug therapy for heart failure
- dietary lapse (eg excessive fluid, salt or alcohol intake)
- tachyarrhythmias such as atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia or sustained ventricular tachycardia
- bradyarrhythmias such as sinus bradycardia or heart block
- myocardial ischaemia or infarction (see Acute coronary syndromes)
- drug therapy1, for example:
- negatively inotropic drugs (eg diltiazem, verapamil)
- salt-retaining drugs (eg corticosteroids, nonsteroidal anti-inflammatory drugs [NSAIDs] including selective cyclo-oxygenase-2 [COX-2] inhibitors)
- thiazolidinediones (pioglitazone)
- certain chemotherapeutic drugs (eg anthracyclines, trastuzumab)
- infection (eg bronchopneumonia, urinary tract infection, endocarditis)
- pulmonary embolism
- iron deficiency
- anaemia
- worsening kidney function
- hyperthyroidism or excessive thyroxine replacement therapy
- acute valvular dysfunction (eg mechanical valve dysfunction including rupture of mitral valve chordae tendineae, perforated valve).