Acute decompensated heart failure (ADHF) involves a buildup of fluid in the body and blood flow problems, leading to shortness of breath, fatigue, faintness, and swelling in the lower limbs. It can be a warning sign of the worsening of existing heart failure.

Signs and symptoms of acute decompensated heart failure (ADHF) can occur gradually or suddenly. The condition can be life threatening, and people will require medical treatment immediately.

This article looks at what ADHF is, the signs and symptoms to look out for, causes, risk factors, treatments, and the outlook for ADHF.

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ADHF is the sudden or gradual occurrence of signs or symptoms of heart failure.

People with ADHF present with various indications of heart failure, including blood flow issues and fluid buildup in the body. These require urgent medical treatment.

Research suggests that ADHF is not just a worsening of chronic heart failure but a separate clinical condition with certain underlying causes. As such, it requires specific treatment.

According to a 2020 article, ADHF results in over 1 million people requiring hospitalization annually in the United States.

Symptoms of ADHF may include:

  • shortness of breath
  • intolerance to exercise
  • heart palpitations
  • feeling faint
  • swelling in the feet, ankles, legs, or arms and hands
  • abdominal bloating
  • feeling full after only eating a small amount of food
  • fatigue

Heart failure occurs when the heart cannot pump blood as well as a person typically can, meaning the cells in the body do not receive enough blood rich in oxygen and nutrients.

The body takes measures to compensate for heart failure. They include the following:

  • the heart stretches and becomes larger to pump more blood
  • the heart increases muscle mass to pump more strongly and quickly to ensure enough blood reaches the body
  • blood vessels narrow to increase blood pressure to compensate for a lack of power from the heart
  • the body prioritizes blood to the most important organs and tissues and away from organs such as the kidneys

As heart failure worsens, these compensating factors are not enough to keep the body functioning typically. People may then experience symptoms such as shortness of breath and fatigue.

According to a 2021 article, ADHF may occur when volume overload and congestion — when the body has an excess buildup of fluid — becomes too much for the body to compensate for. This results in increased pressure in the left, right, or both lower chambers of the heart, leading to the symptoms of ADHF.

Underlying health issues may also increase the risk of ADHF, including diabetes, high blood pressure, and coronary artery disease.

Risk factors for ADHF may include:

  • acute coronary syndrome, which are conditions that cause a sudden, reduced blood flow to the heart
  • high blood pressure
  • diabetes
  • ischemic heart disease
  • chronic obstructive pulmonary disease
  • a history of stroke or transient ischemic attack
  • chronic kidney disease
  • being of older age
  • a history of heart attack, heart bypass surgery, or infections

Treatment for ADHF may include the below.

ACE inhibitors and ARBs

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are medications that reduce high blood pressure. They may help improve the outcome of cardiovascular conditions.

ACE inhibitors and ARBs may help reduce hospital readmission and mortality rates from ADHF.


Beta-blockers are drugs that block the release of adrenaline to reduce pressure on the heart.

People with ADHF who take beta-blockers may have a lower risk of death 60–90 days following discharge from the hospital than those not taking beta-blockers.


Diuretics are medications that help the body eliminate excess water and salt through urine. Diuretics may help reduce fluid buildup in ADHF.

Mineralocorticoid receptor antagonists (MRA), such as spironolactone and eplerenone, are diuretics that doctors may use to treat heart failure.


Ivabradine is a drug that may help prevent heart failure from worsening. Doctors may use ivabradine in addition to beta-blockers.


Digoxin is a type of medication that may help treat heart failure. They may also reduce readmission rates in people with certain types of left-sided heart failure.

ADHF may have more severe outcomes than a heart attack. As many as 50% of ADHF cases may result in hospitalization or death within 6 months of the initial occurrence of ADHF.

In the first 30 days after discharge from the hospital, close monitoring of the condition is important to reduce the worsening of ADHF and readmission.

Treatment with medications both during and after hospitalization for ADHF is important in improving the management of the condition and quality of life.

Experts are still investigating ADHF to understand it fully. Further research may help improve treatment and ways of managing the condition to improve outcomes.

ADHF is a type of heart failure that may occur suddenly or gradually. It could indicate the worsening of existing heart failure. People need urgent medical treatment for ADHF.

The symptoms of ADHF can include shortness of breath, fatigue, feeling faint, and swelling in the lower limbs. If people experience these symptoms, they will need to contact a doctor straight away.

Treatment for ADHF may include a combination of medications to treat heart failure, both during and after hospitalization.