Congestive heart failure clinical assessment: Difference between revisions
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* [[Coronary angiogram]], [[cardiac MRI]], [[biopsy]], other appropriate studies | * [[Coronary angiogram]], [[cardiac MRI]], [[biopsy]], other appropriate studies | ||
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==Clinical Assessment== | ==Clinical Assessment== | ||
Revision as of 14:16, 16 February 2022
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Resident Survival Guide |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Diagnostic algorithm for heart failure
Suspected heart failure
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| NT-proBNP ≥ 125 pg/mL or BNP ≥ 35 pg/mL
or if HF strongly suspected or if NT-proBNP/BNP unavailable | |||||||||||||||||||||||||||||||||||||||
| Echocardiography | |||||||||||||||||||||||||||||||||||||||
| Abnormal findings | |||||||||||||||||||||||||||||||||||||||
| Hear failure unlikely, other dignosis shoulb be considered | NO | Yes | |||||||||||||||||||||||||||||||||||||
| Heart failure confirmed based on LVEF | |||||||||||||||||||||||||||||||||||||||
| LVEF≤ 40% | LVEF=41-49% | LVEF≥50% | |||||||||||||||||||||||||||||||||||||
| The above table adopted from 2021 ESC Guideline |
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Initial studies for evaluation of HFrEF
- BNP, NT Pro BNP
- CBC, basic metabolic panel, liver function, Iron studies, thyroid studies, Hb A1C
- ECG
- CXR
- Echocardiography
- Coronary angiogram, cardiac MRI, biopsy, other appropriate studies
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Clinical Assessment
Framingham Criteria
Major Criteria
- Paroxysmal nocturnal dyspnea
- Jugular vein distention
- Rales
- Radiographic cardiomegaly
- Acute pulmonary edema
- Third heart sound (S3)
- Central venous pressure > 16 cm H2O
- Circulation time ≥ 25 sec
- Hepatojugular reflux
- Pulmonary edema
- Visceral congestion
- Cardiomegaly at autopsy
- Weight loss ≥ 4.5 kg in 5 days in response to treatment of heart failure
Minor Criteria
- Bilateral ankle edema
- Nocturnal cough
- Dyspnea on ordinary exertion
- Hepatomegaly
- Pleural effusion
- 30% decrease in baseline vital capacity
- Tachycardia
Boston Criteria of Congestive Heart Failure
Category I: History
- Rest dyspnea 4 points
- Orthopnea 4 points
- Paroxysmal nocturnal dyspnea 3 points
- Dyspnea on walking on level ground 2 points
- Dyspnea on climbing 1 point
Category II: Physical Examination
- Heart rate abnormality (1 point if 91 to 110 bpm; if >110 bpm, 2 points)
- Jugular venous pressure elevation (2 points if >6 cm H2O; 3 points if >6 cm H2O and hepatomegaly or edema)
- Lung crackles (1 point if basilar; 2 points if more than basilar)
- Wheezing 3 points
- Third heart sound 3 points
Category III: Chest Radiography
- Alveolar pulmonary edema 4 points
- Interstitial pulmonary edema 3 points
- Bilateral pleural effusion 3 points
- Cardiothoracic ratio >0.50 (posteroanterior projection) 3 points
- Upper zone flow redistribution 2 points
No more than 4 points are allowed from each of three categories; hence the composite score (the sum of the subtotal from each category) has a possible maximum of 12 points.
The diagnosis of heart failure is classified as "definite" at a score of 8 to 12 points, "possible" at a score of 5 to 7 points, and "unlikely" at a score of 4 points or less.
References
- ↑ McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland J, Coats A, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam C, Lyon AR, McMurray J, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano G, Ruschitzka F, Kathrine Skibelund A (September 2021). "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure". Eur Heart J. 42 (36): 3599–3726. doi:10.1093/eurheartj/ehab368. PMID 34447992 Check
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