CHF exacerbation can be induced by the following FAILURES

  • Forgetting medications or taking drugs that can worsen HF (e.g. BB, CCB, NSAIDs, TZDs), chemo (anthracyclines, trastuzumab), toxins.
  • Arrhythmia (esp. AF)
  • Ischemia or infarction; myocarditis; Acute vascular dysfunction (e.g. endocarditis), especially mitral or aortic regurgitation.
  • Lifestyle choices: Dietary indiscretions- high salt, alcohol, excessive fluid intake. Obesity.
  • Upregulation (pregnancy and hyperthyroidism)
  • Renal failure (acute, progression of CKD, or insufficient dialysis) lead to increase in preload.
  • Embolus (pulmonary) or COPD – lead to increase right-sided afterload
  • Stenosis (worsening AS, RAS) leading to hypertensive crisis. The HTN crisis leads to increase left-sided afterload. Systemic infection and anemia may also cause CHF exacerbation.
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