Acute Decompensated Chronic Heart Failure: Symptoms, Causes, and Treatments

Medically Reviewed By Angela Ryan Lee, MD, FACC
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Acute decompensated chronic heart failure (ADCHF) occurs when you have a heart failure diagnosis and your symptoms suddenly increase in severity. Medications such as diuretics and beta-blockers can help manage ADCHF. Whether you’re in the early or later stages of heart failure, you live with its effects daily. Symptoms such as shortness of breath, swelling, weakness, and an irregular heartbeat may be familiar signs of this long-term condition. 

However, if your symptoms worsen to the point that you need unplanned medical attention, you may be experiencing ADCHF.

This article looks at the symptoms and causes of ADCHF. It also discusses risk factors, treatment options, and when to contact a doctor.

What are the symptoms of acute decompensated chronic heart failure?

Overhead view of person draw anatomical drawing of heart
Martí Sans/Stocksy United

The symptoms of ADCHF are the same as the symptoms of heart failure but with heightened severity. These include: 

  • difficulty breathing
  • weight gain from water retention
  • increased swelling in your abdomen, legs, and arms
  • feeling extremely fatigued or nauseous after increased movement 
  • confusion 
  • coughing
  • wheezing
  • decreased appetite or feeling full quickly
  • heart palpitations
  • fainting or feeling faint

Learn more about the symptoms of heart failure.

What causes acute decompensated chronic heart failure?

When your heart is not pumping as well as it should be, your body tries to adapt. Since your body believes you are lacking fluid, it compensates by:

  • increasing your blood pressure
  • raising your heart rate
  • holding onto sodium and water

Even though your body can maintain these changes for a while, your symptoms may eventually worsen. This can occur suddenly or gradually and is an indication you are experiencing ADCHF.

There are many factors that can aggravate symptoms of heart failure and lead to ADCHF. For example, heart failure can occur suddenly if you sustain a heart injury.

In most cases, however, heart failure develops gradually due to factors such as:

An older 2013 review lists additional triggering factors for ADCHF, including:

  • strenuous physical activity
  • pulmonary embolism
  • certain medications, including anti-inflammatory medications 
  • consuming large amounts of alcohol
  • pregnancy

Learn more about the common causes of heart failure.

What are treatments for acute decompensated chronic heart failure?

Various treatments are available to help you manage symptoms of ADCHF.

Your cardiologist will tailor heart failure treatment to your specific circumstances. This can include the type of heart failure and other underlying conditions you may have.

Treatment options for ADCHF include:

  • Diuretics: These medications increase urine production, which helps remove excess fluid from blood vessels and other areas of the body. This helps lower blood pressure and reduces symptoms of congestive heart failure.
  • Inotropes: Certain types of these intravenous (IV) medications can help increase the pumping strength of your heart. Your doctor may prescribe them as a short-term or long-term treatment.
  • Vasodilators: These medications help lower blood pressure by preventing blood vessels from constricting. Examples include angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs).


Treatment can also include beta-blockers. These medications help lower heart rate.

For people with chronic heart failure with reduced ejection fraction (HFrEF), they can lower the risk of hospitalization or death. If you are already on a beta-blocker, your doctor will likely continue it during an acute heart failure exacerbation. 

However, starting a beta-blocker can be harmful in acutely decompensated heart failure. Your doctor may hold your prescription or recommended reduced dose if you have severe symptoms.

When should I see a doctor for symptoms of acute decompensated chronic heart failure?

Seek immediate medical help if you experience any increase in symptoms of heart failure. You may require hospital admission for medication and monitoring.

If you have a heart failure diagnosis, contact your cardiologist if you have concerns about your symptoms or your current treatment plan.

Our heart failure appointment guide can help you to prepare for your appointment.

How common is acute decompensated chronic heart failure?

ADCHF is one of the leading diagnoses for hospital admission worldwide. It is the most common form of acute heart failure.

What are the potential complications of acute decompensated heart failure?

With ADCHF, the heart does not pump blood efficiently. This can have effects on every organ in the body. Potential complications of ADCHF include

  • kidney damage or kidney failure
  • arrhythmias
  • liver problems
  • altered mental status

Seeking immediate medical advice as soon as you have concerns about symptoms of heart failure or ADCHF may help reduce your risk of complications.

What is the outlook for acute decompensated heart failure?

The outlook for ADCHF varies depending on several factors. These include a person’s specific diagnosis, medical history, and any underlying conditions.

Generally, people with chronic heart failure who require hospitalization have a higher risk of fatal complications. It is important to follow your prescribed heart failure treatment plan and seek prompt treatment for worsening symptoms. This can help lower your likelihood of hospitalization, improve your quality of life, and extend life expectancy.

Your cardiologist will discuss your outlook with you in the context of your individual diagnosis and treatment plan.

Other frequently asked questions

Here are some other questions people often ask about ADCHF. Angela Ryan Lee, M.D., has reviewed these answers.

What is the difference between heart failure and acute decompensated chronic heart failure?

Heart failure is a progressive disease. It refers to when your heart cannot pump enough blood to meet your body’s demands. Acute decompensated chronic heart failure occurs when heart failure symptoms increase in severity to the point where you need emergency medical assistance.

What stage of heart failure is acute decompensated chronic heart failure?

Acute decompensated chronic heart failure means your symptoms have worsened. Because of this, it indicates that your heart failure is at stage C or D. If your worsening symptoms are only present when you are active, you are at stage C. When heart failure progresses to the point that you experience symptoms even at rest, this is stage D heart failure. This is the most severe stage.

Can acute decompensated chronic heart failure be cured?

Chronic heart failure is not considered curable. However, medications can help reduce symptoms. In more severe cases, treatments such as cardiac assist devices or heart transplant surgery may effectively manage symptoms.


Acute decompensated chronic heart failure (ADCHF) happens when heart failure symptoms worsen to the point that you require immediate medical attention. Doctors diagnose people with this condition if they already have a heart failure diagnosis and the symptoms now require unplanned medical intervention. 

Symptoms of ADCHF are the same as heart failure symptoms, but with increased severity. They include shortness of breath, confusion, increased swelling in your abdomen and legs, and weight gain from water retention. 

There is no cure for ADCHF. However, seeking emergency treatment can help you manage symptoms and reduce the risk of irreversible organ damage.

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Medical Reviewer: Angela Ryan Lee, MD, FACC
Last Review Date: 2023 Mar 16
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