Congestive heart failure clinical assessment: Difference between revisions
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===Criteria for definition of advanced [[heart failure]]=== | ===Criteria for definition of advanced [[heart failure]]=== | ||
1. Severe and persistent symptoms of [[heart failure]] [NYHA class III (advanced) or IV]. | 1. Severe and persistent symptoms of [[heart failure]] [NYHA class III (advanced) or IV].<br> | ||
2. Severe [[cardiac]] dysfunction is defined by at least one of the following: | 2. Severe [[cardiac]] dysfunction is defined by at least one of the following:<br> | ||
* [[LVEF]] <_30% | |||
* Isolated [[RV]] failure ([[ARVC]]) | |||
* Non-operable severe [[valve]] abnormalities | |||
* Non-operable severe [[congenital]] abnormalities | |||
* Persistently high (or increasing) [[BNP]] or [[NT-proBNP]] values and severe [[LV diastolic dysfunction]] or structural abnormalities <br> | |||
3. Episodes of [[pulmonary]] or [[systemic congestion]] requiring high-dose i.v. [[diuretics]] (or [[diuretic]] combinations) or episodes of low [[output]] requiring [[inotropes]] or [[vasoactive]] drugs or [[malignant arrhythmias]] causing >1 unplanned visit or hospitalization in the last 12 months | 3. Episodes of [[pulmonary]] or [[systemic congestion]] requiring high-dose i.v. [[diuretics]] (or [[diuretic]] combinations) or episodes of low [[output]] requiring [[inotropes]] or [[vasoactive]] drugs or [[malignant arrhythmias]] causing >1 unplanned visit or hospitalization in the last 12 months<br> | ||
4. Severe impairment of [[exercise capacity]] with inability to [[exercise]] or low 6MWT distance (<300 m) or [[pVO2]] <12 mL/kg/min or <50% predicted value, estimated to be of [[cardiac]] origin<ref name="pmid34447992">{{cite journal |vauthors=McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A |title=2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure |journal=Eur Heart J |volume=42 |issue=36 |pages=3599–3726 |date=September 2021 |pmid=34447992 |doi=10.1093/eurheartj/ehab368 |url=}}</ref> | 4. Severe impairment of [[exercise capacity]] with inability to [[exercise]] or low 6MWT distance (<300 m) or [[pVO2]] <12 mL/kg/min or <50% predicted value, estimated to be of [[cardiac]] origin<ref name="pmid34447992">{{cite journal |vauthors=McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A |title=2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure |journal=Eur Heart J |volume=42 |issue=36 |pages=3599–3726 |date=September 2021 |pmid=34447992 |doi=10.1093/eurheartj/ehab368 |url=}}</ref> | ||
===Initial studies for evaluation of [[HFrEF]]=== | ===Initial studies for evaluation of [[HFrEF]]=== | ||
Revision as of 08:28, 22 February 2022
 |
Resident Survival Guide |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Diagnostic algorithm for heart failure
Suspected heart failure
| |||||||||||||||||||||||||||||||||||||||
| 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 |
|---|
Criteria for definition of advanced heart failure
1. Severe and persistent symptoms of heart failure [NYHA class III (advanced) or IV].
2. Severe cardiac dysfunction is defined by at least one of the following:
- LVEF <_30%
- Isolated RV failure (ARVC)
- Non-operable severe valve abnormalities
- Non-operable severe congenital abnormalities
- Persistently high (or increasing) BNP or NT-proBNP values and severe LV diastolic dysfunction or structural abnormalities
3. Episodes of pulmonary or systemic congestion requiring high-dose i.v. diuretics (or diuretic combinations) or episodes of low output requiring inotropes or vasoactive drugs or malignant arrhythmias causing >1 unplanned visit or hospitalization in the last 12 months
4. Severe impairment of exercise capacity with inability to exercise or low 6MWT distance (<300 m) or pVO2 <12 mL/kg/min or <50% predicted value, estimated to be of cardiac origin[1]
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
=
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
- ↑ 1.0 1.1 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
|pmid=value (help). Vancouver style error: initials (help)