6th May 2025

Complications

Complication	Management
Acute decompensated heart failure Pulmonary oedema Pleural effusion	Monitor oxygen requirements ; may require continuous positive airway pressure (CPAP) in type 1 respiratory failure (T1RF) if not responding to high flow oxygen Intravenous diuretics Fluid monitoring chart (consider catheterisation for accurate fluid balance, particularly in cases with concomitant renal insufficiency) Daily weights
Cardiorenal syndrome	Inadequate cardiac output leads to reduced renal perfusion pressure. Activation of the sympathetic nervous system and the RAAS due to ineffective circulating volume results in vasoconstriction, further reducing renal blood flow and perfusion. Optimise heart failure therapy Optimise diuretic therapy with careful renal function monitoring as reducing the circulatory volume can increase renal perfusion pressure.
Cardiogenic shock	Patients with end-stage heart failure can eventually progress into multiorgan failure. Cardiogenic shock typically occurs with large ischemic events (i.e.: myocardial infarction) but patients with heart failure can suddenly ‘fall off the cliff’.
Sudden cardiac death	Dysfunctional myocardium remodelling can result in aberrant electrical pathways, predisposing patients to serious arrhythmias such as ventricular fibrillation, leading to sudden cardiac death. These patients require an implantable cardiac defibrillator.

Table 7: Main complications of heart failure

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