Materiały źródłowe

• #1 Diagnosis and Evaluation of Heart Failure | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0615/p1161.html

  Heart failure is a common clinical syndrome characterized by dyspnea, fatigue, and signs of volume overload, which may include peripheral edema and pulmonary rales. Heart failure has high morbidity and mortality rates, especially in older persons. The initial evaluation includes a history and physical examination, chest radiography, electrocardiography, and laboratory assessment to identify causes or precipitating factors. A displaced cardiac apex, a third heart sound, and chest radiography findings of venous congestion or interstitial edema are useful in identifying heart failure. There is no single diagnostic test for heart failure; therefore, it remains a clinical diagnosis requiring a history, physical examination, and laboratory testing. Appropriate diagnosis and therapy for heart failure are important given the poor prognosis. Echocardiography is the diagnostic standard to confirm systolic or diastolic heart failure through assessment of left ventricular ejection fraction. Evaluation for ischemic heart disease is warranted in patients with heart failure, especially if angina is present, given that coronary artery disease is the most common cause of heart failure.

• #2 Heart failure: Clinical manifestations and diagnosis in adults – UpToDate

  https://www.uptodate.com/contents/heart-failure-clinical-manifestations-and-diagnosis-in-adults

  Heart failure: Clinical manifestations and diagnosis in adults […] The initial evaluation of the patient with suspected HF will be reviewed here. […] There is no single, noninvasive diagnostic test that serves as a gold standard for HF, since it is largely a clinical diagnosis based upon a careful history, physical examination, laboratory and imaging data. […] The clinical diagnosis of HF is limited to patients with current or prior symptoms of HF (American College of Cardiology/American Heart Association [ACC/AHA] stages C and D HF) and excludes patients with stage A (at high risk for HF but without structural heart disease or symptoms of HF) or stage B HF (structural heart disease but no symptoms or signs of HF). […] HF is caused by a number of conditions, including LV dysfunction, RV dysfunction, valvular heart disease, pericardial disease, obstructive lesions in the heart or great vessels, or high-output HF.

• #3 Heart failure: Clinical manifestations and diagnosis in adults – UpToDate

  https://www.uptodate.com/contents/heart-failure-clinical-manifestations-and-diagnosis-in-adults

  Heart failure: Clinical manifestations and diagnosis in adults […] The initial evaluation of the patient with suspected HF will be reviewed here. […] There is no single, noninvasive diagnostic test that serves as a gold standard for HF, since it is largely a clinical diagnosis based upon a careful history, physical examination, laboratory and imaging data. […] The clinical diagnosis of HF is limited to patients with current or prior symptoms of HF (American College of Cardiology/American Heart Association [ACC/AHA] stages C and D HF) and excludes patients with stage A (at high risk for HF but without structural heart disease or symptoms of HF) or stage B HF (structural heart disease but no symptoms or signs of HF). […] HF is caused by a number of conditions, including LV dysfunction, RV dysfunction, valvular heart disease, pericardial disease, obstructive lesions in the heart or great vessels, or high-output HF.

• #4 Diagnosis and Evaluation of Heart Failure | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0615/p1161.html

  Heart failure is a common clinical syndrome characterized by dyspnea, fatigue, and signs of volume overload, which may include peripheral edema and pulmonary rales. Heart failure has high morbidity and mortality rates, especially in older persons. The initial evaluation includes a history and physical examination, chest radiography, electrocardiography, and laboratory assessment to identify causes or precipitating factors. A displaced cardiac apex, a third heart sound, and chest radiography findings of venous congestion or interstitial edema are useful in identifying heart failure. There is no single diagnostic test for heart failure; therefore, it remains a clinical diagnosis requiring a history, physical examination, and laboratory testing. Appropriate diagnosis and therapy for heart failure are important given the poor prognosis. Echocardiography is the diagnostic standard to confirm systolic or diastolic heart failure through assessment of left ventricular ejection fraction. Evaluation for ischemic heart disease is warranted in patients with heart failure, especially if angina is present, given that coronary artery disease is the most common cause of heart failure.

• #5 Clinical manifestations and diagnosis of advanced heart failure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-advanced-heart-failure

  Clinical manifestations and diagnosis of advanced heart failure […] An overview of the clinical manifestations and diagnosis of advanced HF will be presented here. […] Symptoms and signs — While signs and symptoms of advanced HF are variable, common manifestations of advanced HF include exercise intolerance, unintentional weight loss, refractory volume overload, recurrent ventricular arrhythmias, as well as hypotension and signs of inadequate perfusion (eg, low pulse pressure). […] Mortality risk increases with each subsequent HF hospitalization. […] Dyspnea, fatigue, and exercise intolerance — As HF progresses, patients frequently develop symptoms such as dyspnea, lightheadedness, or fatigue at rest or with minimal exertion that limits exercise capacity. […] Poor functional status is an adverse prognostic indicator in patients with HF.

• #6 Clinical manifestations and diagnosis of advanced heart failure – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-advanced-heart-failure

  Clinical manifestations and diagnosis of advanced heart failure […] An overview of the clinical manifestations and diagnosis of advanced HF will be presented here. […] Symptoms and signs — While signs and symptoms of advanced HF are variable, common manifestations of advanced HF include exercise intolerance, unintentional weight loss, refractory volume overload, recurrent ventricular arrhythmias, as well as hypotension and signs of inadequate perfusion (eg, low pulse pressure). […] Mortality risk increases with each subsequent HF hospitalization. […] Dyspnea, fatigue, and exercise intolerance — As HF progresses, patients frequently develop symptoms such as dyspnea, lightheadedness, or fatigue at rest or with minimal exertion that limits exercise capacity. […] Poor functional status is an adverse prognostic indicator in patients with HF.

• #7 Diagnosis and Evaluation of Heart Failure | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0615/p1161.html

  Heart failure is a common clinical syndrome characterized by dyspnea, fatigue, and signs of volume overload, which may include peripheral edema and pulmonary rales. Heart failure has high morbidity and mortality rates, especially in older persons. The initial evaluation includes a history and physical examination, chest radiography, electrocardiography, and laboratory assessment to identify causes or precipitating factors. A displaced cardiac apex, a third heart sound, and chest radiography findings of venous congestion or interstitial edema are useful in identifying heart failure. There is no single diagnostic test for heart failure; therefore, it remains a clinical diagnosis requiring a history, physical examination, and laboratory testing. Appropriate diagnosis and therapy for heart failure are important given the poor prognosis. Echocardiography is the diagnostic standard to confirm systolic or diastolic heart failure through assessment of left ventricular ejection fraction. Evaluation for ischemic heart disease is warranted in patients with heart failure, especially if angina is present, given that coronary artery disease is the most common cause of heart failure.

• #8 Diagnosis of Heart Failure in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1201/p2145.html

  Heart failure is a common, progressive, complex clinical syndrome with high morbidity and mortality. The evaluation of symptomatic patients with suspected heart failure is directed at confirming the diagnosis, determining the cause, identifying concomitant illnesses, establishing the severity of heart failure, and guiding therapy. The initial evaluation should include a focused history and physical examination, a chest radiograph, and an electrocardiogram. The presence of heart failure can be confirmed by an echocardiogram. Heart failure is highly unlikely in the absence of dyspnea and an abnormal chest radiograph or electrocardiogram. Patients with confirmed heart failure should undergo additional testing, including a more detailed history and physical examination; a complete blood count; blood glucose measurement; liver function tests; serum electrolyte, blood urea nitrogen, and creatinine measurements; lipid panel; urinalysis; and thyroid-stimulating hormone level. The initial evaluation of patients with suspected heart failure should include a focused history and physical examination, an ECG, and a chest radiograph. An echocardiogram can confirm the diagnosis. Heart failure can be ruled in if jugular venous distention, displacement of the apical pulsation, or a gallop rhythm is present. Absence of dyspnea or a normal ECG and chest radiograph make the diagnosis of heart failure highly unlikely. Heart failure is a clinical diagnosis, and no single test can establish its presence or absence. In patients with this condition, the most frequent clinical findings are related to decreased exercise tolerance or fluid retention. Decreased exercise tolerance typically presents as dyspnea or, much less commonly, fatigue on exertion. Fluid retention results in orthopnea, rales, elevated jugular venous pressure, dependent edema, and the typical radiographic findings of cardiomegaly, pulmonary edema, and pleural effusion. Nearly all patients with heart failure present with dyspnea. The absence of dyspnea makes heart failure highly unlikely (sensitivity: greater than 95 percent), and other explanations for the patients symptoms should be sought first. A chest radiograph and an electrocardiogram should be obtained in patients with dyspnea and suspected heart failure. A normal chest radiograph slightly decreases the probability of heart failure and helps identify pulmonary causes of dyspnea. A normal electrocardiogram makes heart failure unlikely (sensitivity: 94 percent). If both the electrocardiogram and chest radiograph are normal, heart failure is highly unlikely (sensitivity: 95 percent or greater), and other causes should be considered. Heart failure is strongly suggested by the presence of cardiomegaly or pulmonary vascular congestion on the chest radiograph. The echocardiogram is the diagnostic standard for identifying both systolic and diastolic heart failure. The diagnosis of diastolic dysfunction is problematic. Diagnostic criteria for this type of heart failure are poorly defined, diastolic dysfunction often is present in patients who also have left ventricular systolic dysfunction, and most patients with diastolic dysfunction have other conditions that could explain their symptoms. Currently, Doppler echocardiography is the primary tool for identifying abnormal diastolic function, including diminished early diastolic filling and reduced ventricular compliance associated with diastolic dysfunction. The evaluation of symptomatic patients with suspected heart failure is directed at confirming the presence of heart failure, determining the cause, identifying comorbid illnesses, establishing the severity of heart failure, and guiding therapy.

• #9 Heart failure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148

  To diagnose heart failure, your healthcare professional examines you and asks questions about your symptoms and medical history. […] Your care professional listens to your lungs and heart with a device called a stethoscope. […] Tests that may be done to diagnose heart failure may include: […] Blood tests can help diagnose diseases that can affect the heart. […] X-ray images can show the condition of the lungs and heart. […] This quick and painless test records the electrical signals in the heart. […] Sound waves create images of the beating heart. […] Ejection fraction is a measurement of the percentage of blood leaving your heart each time it squeezes. […] These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored. […] This test uses X-rays to create cross-sectional images of the heart.

• #10 Diagnosis and Evaluation of Heart Failure | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0615/p1161.html

  Heart failure is a common clinical syndrome characterized by dyspnea, fatigue, and signs of volume overload, which may include peripheral edema and pulmonary rales. Heart failure has high morbidity and mortality rates, especially in older persons. The initial evaluation includes a history and physical examination, chest radiography, electrocardiography, and laboratory assessment to identify causes or precipitating factors. A displaced cardiac apex, a third heart sound, and chest radiography findings of venous congestion or interstitial edema are useful in identifying heart failure. There is no single diagnostic test for heart failure; therefore, it remains a clinical diagnosis requiring a history, physical examination, and laboratory testing. Appropriate diagnosis and therapy for heart failure are important given the poor prognosis. Echocardiography is the diagnostic standard to confirm systolic or diastolic heart failure through assessment of left ventricular ejection fraction. Evaluation for ischemic heart disease is warranted in patients with heart failure, especially if angina is present, given that coronary artery disease is the most common cause of heart failure.

• #11 Diagnosis and Evaluation of Heart Failure | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0615/p1161.html

  The initial evaluation of patients with suspected heart failure should include a history and physical examination, laboratory assessment, chest radiography, and electrocardiography. Echocardiography can confirm the diagnosis. A displaced cardiac apex, a third heart sound, and chest radiography findings of pulmonary venous congestion or interstitial edema are good predictors to rule in the diagnosis of heart failure. Systolic heart failure can be effectively ruled out with a normal B-type natriuretic peptide or N-terminal proB-type natriuretic peptide level. Systolic heart failure can be effectively ruled out when the Framingham criteria are not met. […] The most important consideration when categorizing heart failure is whether left ventricular ejection fraction (LVEF) is preserved or reduced (less than 50 percent). A reduced LVEF in systolic heart failure is a powerful predictor of mortality. Overall, there is no difference in survival between diastolic and systolic heart failure that cannot be attributed to ejection fraction.

• #12 Heart Failure (Congestive Heart Failure) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430873/

  Laboratory investigations recommended in patients with HF include complete blood count (CBC), renal profile, liver enzymes, urine studies, serum B-type natriuretic peptide (BNP), and cardiac enzymes. […] An electrocardiogram (ECG) may show evidence of prior infarction, chamber enlargement, intraventricular conduction delay, or arrhythmia. […] Echocardiography is the initial modality of choice in patients with suspected HF and is a readily available bedside tool. […] Cardiac catheterization is often required for diagnosing ischemic cardiomyopathy and can be helpful in accurately evaluating intracardiac pressures. […] The goal of therapy for chronic HF is to improve symptoms and quality of life, decrease hospitalizations, and improve cardiac mortality. […] Management for the respective stages of HF is outlined by the American College of Cardiology and the American Heart Association.

• #13 Congestive Heart Failure: Symptoms, Stages & Treatment

  https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure

  Congestive heart failure is a long-term condition in which your heart cant pump blood well enough to meet your bodys needs. […] Your healthcare provider will ask you about your symptoms and medical history. […] Heart failure is a chronic condition that gets worse with time. There are four heart failure stages (Stages A, B, C and D). […] Common tests to identify congestive heart failure, its stage and its cause include: Blood tests, Cardiac catheterization, Chest X-ray, Echocardiogram, Heart MRI (magnetic resonance imaging), Cardiac computed tomography (CT), Electrocardiogram (EKG or ECG), Multigated Acquisition Scan (MUGA scan), Stress test, Genetic testing. […] Your treatment will depend on the type of heart failure you have and, in part, what caused it. Medications and lifestyle changes are part of every heart failure treatment plan. […] Its very important for you to manage your other health conditions, such as: Diabetes, Kidney disease, Anemia, High blood pressure, Thyroid disease, Asthma, Chronic lung disease. […] Its important to let your provider know if you have new symptoms or if your heart failure symptoms get worse.

• #14 Heart Failure (Congestive Heart Failure) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430873/

  Laboratory investigations recommended in patients with HF include complete blood count (CBC), renal profile, liver enzymes, urine studies, serum B-type natriuretic peptide (BNP), and cardiac enzymes. […] An electrocardiogram (ECG) may show evidence of prior infarction, chamber enlargement, intraventricular conduction delay, or arrhythmia. […] Echocardiography is the initial modality of choice in patients with suspected HF and is a readily available bedside tool. […] Cardiac catheterization is often required for diagnosing ischemic cardiomyopathy and can be helpful in accurately evaluating intracardiac pressures. […] The goal of therapy for chronic HF is to improve symptoms and quality of life, decrease hospitalizations, and improve cardiac mortality. […] Management for the respective stages of HF is outlined by the American College of Cardiology and the American Heart Association.

• #15 Heart Failure | Choose the Right Test

  https://arupconsult.com/content/heart-failure

  Heart failure (HF), a common clinical syndrome with high morbidity and mortality, results from a structural or functional cardiac issue that leads to impaired ventricular filling or ejection. Signs and symptoms of HF are nonspecific, which presents a diagnostic challenge. These symptoms include dyspnea, fatigue, exercise intolerance, fluid retention, and edema. Measurement of natriuretic peptides, particularly B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), may be used to support a diagnosis of HF, inform prognosis, and monitor disease progression. […] A thorough laboratory workup including a CBC and urinalysis, as well as electrolyte, blood urea nitrogen (BUN), creatinine, glucose, hemoglobin A1c, liver enzyme, lipid, and thyroid function tests, is recommended to evaluate for comorbidities in patients with HF.

• #16 Heart Failure – Diagnosis | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/heart-failure/diagnosis

  Your doctor will diagnose heart failure based on your medical history, a physical exam, and test results. […] You may also be referred to a cardiologist for these tests and treatment. […] Your provider may order blood tests to check the levels of certain molecules, such as brain natriuretic peptide (BNP). These levels rise during heart failure. […] Your provider may order an echocardiography (echo) or other imaging tests to measure your ejection fraction. […] Ejection fraction measures how well your heart pumps. This helps diagnose the type of heart failure you have and guides your treatment. […] If 40% or less of the blood in your left ventricle is pumped out in one beat, you have heart failure with reduced ejection fraction. […] If 50% or more of the blood in your left ventricle is pumped out in one beat, you have heart failure with preserved ejection fraction.

• #17 Heart Failure: Diagnosis, Management and Utilization

  https://www.mdpi.com/2077-0383/5/7/62

  The evaluation for HF is performed using various parameters: physical examination to determine the presence of clinical symptoms and signs, blood tests, including complete blood count, urinalysis, complete metabolic profile for levels of serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, glucose, fasting lipid profile, liver function tests and thyroid-stimulating hormone. […] Other HF-specific laboratory tests (especially in patients with a high possibility of heart failure) include brain natriuretic peptide (BNP) with 70% sensitivity and 99% specificity and N-terminal proBNP (NT-proBNP) with 99% sensitivity and 85% specificity, the measurement which has been recommended both in outpatient and in the hospital settings. […] During the diagnosis of HF, in patients presenting with acute dyspnea, BNP levels of less than 100 pg/mL have a 90% negative predictive value (NPV), and values of more than 500 pg/mL have an 81% positive predictive value (PPV).

• #18 Diagnosis and Evaluation of Heart Failure | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0615/p1161.html

  The initial clinical evaluation is directed at confirming heart failure, determining potential causes, and identifying comorbid illnesses. Evaluation for ischemic heart disease is warranted in patients with heart failure, especially if angina is present, given that CAD is the most common cause of heart failure. […] Laboratory testing can help identify alternative and potentially reversible causes of heart failure. BNP and N-terminal pro-BNP levels can be used to evaluate patients with dyspnea for heart failure. BNP appears to have better reliability than N-terminal pro-BNP, especially in older populations. Multiple systematic reviews have concluded that BNP and N-terminal pro-BNP levels can effectively rule out a diagnosis of heart failure because of their negative predictive value. […] Echocardiography is the most widely accepted and available method for identifying systolic dysfunction and should be performed after the initial evaluation to confirm the presence of heart failure.

• #19 Heart Failure | Choose the Right Test

  https://arupconsult.com/content/heart-failure

  Laboratory testing for HF may be used to: Support a diagnosis of HF in adult patients who present with signs and symptoms of HF or a history of cardiac disease. […] Measurement of natriuretic peptides also aids in HF diagnosis and helps to identify patients who require further assessment. Lower natriuretic peptide values exclude HF, whereas elevated natriuretic peptide values support an HF diagnosis, although natriuretic peptides may be elevated in a number of cardiac and noncardiac conditions. […] Measurement of BNP or NT-proBNP is useful for establishing disease severity and prognosis in chronic HF, and for prognosis in the acute setting. […] Serial natriuretic peptide measurements can be used to evaluate the effect of diuretic therapy and monitor volume status in anticipation of hospital discharge, although the utility of natriuretic peptide levels to reduce hospital stay or mortality has not been well established.

• #20 New developments in the investigations and diagnosis of heart failure

  https://bjcardio.co.uk/2022/07/new-developments-in-the-investigations-and-diagnosis-of-heart-failure/

  This article reviews some of the new concepts, new recommendations, along with changes to recommendations, in the diagnosis and investigation of heart failure (HF) in the European Society of Cardiology (ESC) 2021 Guidelines for the diagnosis and treatment of acute and chronic heart failure, and contrasts these with the 2016 version of the guidelines. […] The 2021 updated guidelines make it clear that we have the means to diagnose HF early, to classify it more accurately, the tools to change the HF trajectory, and the duty and ability to intervene and to do so early. […] While the ESC diagnostic algorithm for HF is not new per se, it is worth reiterating and emphasising, that checking N-terminal pro-B-type natriuretic peptide (NTproBNP) levels and acting on them is the path to timely diagnosis.

• #21

  https://link.springer.com/article/10.1007/s10741-021-10105-w

  Heart failure (HF) is a significant cause of morbidity and mortality worldwide. Circulating biomarkers reflecting pathophysiological pathways involved in HF development and progression may assist clinicians in early diagnosis and management of HF patients. The roles of B-type NP (BNP) and N-terminal pro-B-type NP (NT-proBNP) for diagnosis and risk stratification in HF have been extensively demonstrated, and these biomarkers are emerging tools for population screening and as guides to the start of treatment in subclinical HF. […] American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend the use of BNP and NT-proBNP to diagnose HF (class I, level of evidence (LOE) A), without indicating specific threshold values. Conversely, European Society of Cardiology (ESC) guidelines recommend the use of BNP and NT-proBNP for the exclusion of HF (class IIa, LOE C), with reference values100 ng/L and300 ng/L for acute HF, respectively, and35 ng/L and125 ng/L for chronic HF, respectively.

• #22 Diagnosing heart failure with preserved ejection fraction (HFpEF) – Ultromics

  https://www.ultromics.com/articles/diagnosing-heart-failure-with-preserved-ejection-fraction-hfpef

  However, Framingham’s clinical criteria has excellent sensitivity to exclude the diagnosis of HF in the absence of these symptoms/signs, but it has poor specificity to confirm the diagnosis. […] Echocardiography remains the main evaluation for HFpEF and provides essential information to estimate elevated LV filling pressure. […] The most robust indicators include Doppler transthoracic echocardiography (E/e) to evaluate LVEF, and pulmonary artery systolic pressure (PASP), to assess left ventricular filling pressure. […] However, echocardiography parameters are specific but have low sensitivity, and are most useful for diagnosis when abnormalities are present but do not exclude disease when absent. […] Measurement of natriuretic peptides (NPs) like BNP/NT-proBNP is also helpful in supporting HFpEF diagnosis when the cause of dyspnea is unclear and the physical examination is equivocal.

• #23 Heart failure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148

  To diagnose heart failure, your healthcare professional examines you and asks questions about your symptoms and medical history. […] Your care professional listens to your lungs and heart with a device called a stethoscope. […] Tests that may be done to diagnose heart failure may include: […] Blood tests can help diagnose diseases that can affect the heart. […] X-ray images can show the condition of the lungs and heart. […] This quick and painless test records the electrical signals in the heart. […] Sound waves create images of the beating heart. […] Ejection fraction is a measurement of the percentage of blood leaving your heart each time it squeezes. […] These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored. […] This test uses X-rays to create cross-sectional images of the heart.

• #24 Common Tests for Heart Failure | American Heart Association

  https://www.heart.org/en/health-topics/heart-failure/diagnosing-heart-failure/common-tests-for-heart-failure

  To determine whether you have heart failure, your health care team might perform some or all of these diagnostic tests and procedures. […] The physical exam for heart failure is largely painless. […] Your health care professional can’t make an accurate diagnosis without your full input. […] Abnormal results could indicate a strain on the heart or on other organs such as the kidneys and liver, which often results from heart failure. […] Chest X-rays are painless. […] These images are an initial imaging step in diagnosing heart failure and cannot capture all the details needed for a formal diagnosis. […] An EKG reveals: […] An echocardiogram reveals: […] An exercise stress test reveals: […] A MUGA scan reveals: […] A cardiac catheterization reveals: […] An MRI reveals:

• #25 Diagnosing Heart Failure: Experience and ‘Best Pathways’ | ECR Journal

  https://www.ecrjournal.com/articles/diagnosing-heart-failure-experience-and-best-pathways?language_content_entity=en

  Heart failure is a clinical syndrome associated with high rates of morbidity and mortality and associated healthcare costs. Accurate and timely diagnosis is crucial to ensure patients receive appropriate treatment and avoid hospital admissions. However, diagnosing heart failure can be difficult as symptoms and signs commonly overlap with other conditions. A chest X-ray can be useful to identify evidence of heart failure or other lung pathology; however, a normal result does not rule out a diagnosis of heart failure. An electrocardiogram (ECG) is often abnormal in patients with heart failure, although up to 10% of patients may have a normal ECG. Natriuretic peptides are a useful biomarker for heart failure and a negative result can rule out the diagnosis. This can be helpful in determining who should be referred for echocardiogram. A new clinical-decision rule (CDR) could help clinicians to achieve a more timely and accurate diagnosis of heart failure.

• #26 Diagnosis of Heart Failure in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1201/p2145.html

  Heart failure is a common, progressive, complex clinical syndrome with high morbidity and mortality. The evaluation of symptomatic patients with suspected heart failure is directed at confirming the diagnosis, determining the cause, identifying concomitant illnesses, establishing the severity of heart failure, and guiding therapy. The initial evaluation should include a focused history and physical examination, a chest radiograph, and an electrocardiogram. The presence of heart failure can be confirmed by an echocardiogram. Heart failure is highly unlikely in the absence of dyspnea and an abnormal chest radiograph or electrocardiogram. Patients with confirmed heart failure should undergo additional testing, including a more detailed history and physical examination; a complete blood count; blood glucose measurement; liver function tests; serum electrolyte, blood urea nitrogen, and creatinine measurements; lipid panel; urinalysis; and thyroid-stimulating hormone level. The initial evaluation of patients with suspected heart failure should include a focused history and physical examination, an ECG, and a chest radiograph. An echocardiogram can confirm the diagnosis. Heart failure can be ruled in if jugular venous distention, displacement of the apical pulsation, or a gallop rhythm is present. Absence of dyspnea or a normal ECG and chest radiograph make the diagnosis of heart failure highly unlikely. Heart failure is a clinical diagnosis, and no single test can establish its presence or absence. In patients with this condition, the most frequent clinical findings are related to decreased exercise tolerance or fluid retention. Decreased exercise tolerance typically presents as dyspnea or, much less commonly, fatigue on exertion. Fluid retention results in orthopnea, rales, elevated jugular venous pressure, dependent edema, and the typical radiographic findings of cardiomegaly, pulmonary edema, and pleural effusion. Nearly all patients with heart failure present with dyspnea. The absence of dyspnea makes heart failure highly unlikely (sensitivity: greater than 95 percent), and other explanations for the patients symptoms should be sought first. A chest radiograph and an electrocardiogram should be obtained in patients with dyspnea and suspected heart failure. A normal chest radiograph slightly decreases the probability of heart failure and helps identify pulmonary causes of dyspnea. A normal electrocardiogram makes heart failure unlikely (sensitivity: 94 percent). If both the electrocardiogram and chest radiograph are normal, heart failure is highly unlikely (sensitivity: 95 percent or greater), and other causes should be considered. Heart failure is strongly suggested by the presence of cardiomegaly or pulmonary vascular congestion on the chest radiograph. The echocardiogram is the diagnostic standard for identifying both systolic and diastolic heart failure. The diagnosis of diastolic dysfunction is problematic. Diagnostic criteria for this type of heart failure are poorly defined, diastolic dysfunction often is present in patients who also have left ventricular systolic dysfunction, and most patients with diastolic dysfunction have other conditions that could explain their symptoms. Currently, Doppler echocardiography is the primary tool for identifying abnormal diastolic function, including diminished early diastolic filling and reduced ventricular compliance associated with diastolic dysfunction. The evaluation of symptomatic patients with suspected heart failure is directed at confirming the presence of heart failure, determining the cause, identifying comorbid illnesses, establishing the severity of heart failure, and guiding therapy.

• #27 Heart failure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148

  To diagnose heart failure, your healthcare professional examines you and asks questions about your symptoms and medical history. […] Your care professional listens to your lungs and heart with a device called a stethoscope. […] Tests that may be done to diagnose heart failure may include: […] Blood tests can help diagnose diseases that can affect the heart. […] X-ray images can show the condition of the lungs and heart. […] This quick and painless test records the electrical signals in the heart. […] Sound waves create images of the beating heart. […] Ejection fraction is a measurement of the percentage of blood leaving your heart each time it squeezes. […] These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored. […] This test uses X-rays to create cross-sectional images of the heart.

• #28 Heart Failure (Congestive Heart Failure) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430873/

  Laboratory investigations recommended in patients with HF include complete blood count (CBC), renal profile, liver enzymes, urine studies, serum B-type natriuretic peptide (BNP), and cardiac enzymes. […] An electrocardiogram (ECG) may show evidence of prior infarction, chamber enlargement, intraventricular conduction delay, or arrhythmia. […] Echocardiography is the initial modality of choice in patients with suspected HF and is a readily available bedside tool. […] Cardiac catheterization is often required for diagnosing ischemic cardiomyopathy and can be helpful in accurately evaluating intracardiac pressures. […] The goal of therapy for chronic HF is to improve symptoms and quality of life, decrease hospitalizations, and improve cardiac mortality. […] Management for the respective stages of HF is outlined by the American College of Cardiology and the American Heart Association.

• #29 Diagnosis of Heart Failure in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1201/p2145.html

  Heart failure is a common, progressive, complex clinical syndrome with high morbidity and mortality. The evaluation of symptomatic patients with suspected heart failure is directed at confirming the diagnosis, determining the cause, identifying concomitant illnesses, establishing the severity of heart failure, and guiding therapy. The initial evaluation should include a focused history and physical examination, a chest radiograph, and an electrocardiogram. The presence of heart failure can be confirmed by an echocardiogram. Heart failure is highly unlikely in the absence of dyspnea and an abnormal chest radiograph or electrocardiogram. Patients with confirmed heart failure should undergo additional testing, including a more detailed history and physical examination; a complete blood count; blood glucose measurement; liver function tests; serum electrolyte, blood urea nitrogen, and creatinine measurements; lipid panel; urinalysis; and thyroid-stimulating hormone level. The initial evaluation of patients with suspected heart failure should include a focused history and physical examination, an ECG, and a chest radiograph. An echocardiogram can confirm the diagnosis. Heart failure can be ruled in if jugular venous distention, displacement of the apical pulsation, or a gallop rhythm is present. Absence of dyspnea or a normal ECG and chest radiograph make the diagnosis of heart failure highly unlikely. Heart failure is a clinical diagnosis, and no single test can establish its presence or absence. In patients with this condition, the most frequent clinical findings are related to decreased exercise tolerance or fluid retention. Decreased exercise tolerance typically presents as dyspnea or, much less commonly, fatigue on exertion. Fluid retention results in orthopnea, rales, elevated jugular venous pressure, dependent edema, and the typical radiographic findings of cardiomegaly, pulmonary edema, and pleural effusion. Nearly all patients with heart failure present with dyspnea. The absence of dyspnea makes heart failure highly unlikely (sensitivity: greater than 95 percent), and other explanations for the patients symptoms should be sought first. A chest radiograph and an electrocardiogram should be obtained in patients with dyspnea and suspected heart failure. A normal chest radiograph slightly decreases the probability of heart failure and helps identify pulmonary causes of dyspnea. A normal electrocardiogram makes heart failure unlikely (sensitivity: 94 percent). If both the electrocardiogram and chest radiograph are normal, heart failure is highly unlikely (sensitivity: 95 percent or greater), and other causes should be considered. Heart failure is strongly suggested by the presence of cardiomegaly or pulmonary vascular congestion on the chest radiograph. The echocardiogram is the diagnostic standard for identifying both systolic and diastolic heart failure. The diagnosis of diastolic dysfunction is problematic. Diagnostic criteria for this type of heart failure are poorly defined, diastolic dysfunction often is present in patients who also have left ventricular systolic dysfunction, and most patients with diastolic dysfunction have other conditions that could explain their symptoms. Currently, Doppler echocardiography is the primary tool for identifying abnormal diastolic function, including diminished early diastolic filling and reduced ventricular compliance associated with diastolic dysfunction. The evaluation of symptomatic patients with suspected heart failure is directed at confirming the presence of heart failure, determining the cause, identifying comorbid illnesses, establishing the severity of heart failure, and guiding therapy.

• #30 Heart failure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148

  To diagnose heart failure, your healthcare professional examines you and asks questions about your symptoms and medical history. […] Your care professional listens to your lungs and heart with a device called a stethoscope. […] Tests that may be done to diagnose heart failure may include: […] Blood tests can help diagnose diseases that can affect the heart. […] X-ray images can show the condition of the lungs and heart. […] This quick and painless test records the electrical signals in the heart. […] Sound waves create images of the beating heart. […] Ejection fraction is a measurement of the percentage of blood leaving your heart each time it squeezes. […] These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored. […] This test uses X-rays to create cross-sectional images of the heart.

• #31 Diagnosis and Evaluation of Heart Failure | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0615/p1161.html

  The initial clinical evaluation is directed at confirming heart failure, determining potential causes, and identifying comorbid illnesses. Evaluation for ischemic heart disease is warranted in patients with heart failure, especially if angina is present, given that CAD is the most common cause of heart failure. […] Laboratory testing can help identify alternative and potentially reversible causes of heart failure. BNP and N-terminal pro-BNP levels can be used to evaluate patients with dyspnea for heart failure. BNP appears to have better reliability than N-terminal pro-BNP, especially in older populations. Multiple systematic reviews have concluded that BNP and N-terminal pro-BNP levels can effectively rule out a diagnosis of heart failure because of their negative predictive value. […] Echocardiography is the most widely accepted and available method for identifying systolic dysfunction and should be performed after the initial evaluation to confirm the presence of heart failure.

• #32 Types of Heart Failure and Diagnosis | HFSA

  https://hfsa.org/types-heart-failure-and-diagnosis

  Heart failure is diagnosed by a constellation of symptoms and signs of fluid overload due to either a weak heart (heart failure with reduced ejection fraction, or HFrEF) or a strong heart with poor heart relaxation (heart failure with preserved ejection fraction or HFpEF). Ejection fraction (EF) measures the amount of blood the left ventricle pumps out with each contraction. People with a healthy heart have an EF of about 60%, while people with heart failure have a reduced ejection fraction with EF 40% (HFrEF), a mildly reduced ejection fraction with EF at 40-49%, or a preserved ejection fraction with EF 50% (HFpEF). […] Medical providers often order an echocardiogram, or echo to determine the strength of the heart. An echocardiogram is an ultrasound of the heart that measures the ejection fraction (EF), wall thickness, and the flow of blood through valves in your heart.

• #33 Heart Failure (HF) – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/heart-failure/heart-failure-hf

  Echocardiography can help evaluate chamber dimensions, valve function, LVEF, wall motion abnormalities, LV hypertrophy, diastolic function, pulmonary artery pressure, LV and RV filling pressures, RV function, and pericardial effusion. […] Serum BNP levels are often high in heart failure; this finding may help when clinical findings are unclear or other diagnoses (eg, COPD) need to be excluded.

• #34 Heart Failure (Congestive Heart Failure) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430873/

  The treatment of HF requires a multifaceted approach involving patient education, optimal medication administration, and decreasing acute exacerbations. […] The following parameters are used to classify HF based on LVEF: HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction, HF with preserved ejection fraction (HFpEF), and HF with improved ejection fraction. […] The ACC/AHA Stages of HF are as follows: Stage A: At risk for HF. Stage B: Pre-HF. Stage C: Symptomatic HF. Stage D: Advanced HF. […] The diagnosis and classification of HF are primarily based on the presence and severity of symptoms and physical exam findings. […] The commonly used Framingham Diagnostic Criteria for Heart Failure require the presence of 2 major criteria or 1 major and 2 minor criteria to make the diagnosis.

• #35 Types of Heart Failure and Diagnosis | HFSA

  https://hfsa.org/types-heart-failure-and-diagnosis

  Heart failure is diagnosed by a constellation of symptoms and signs of fluid overload due to either a weak heart (heart failure with reduced ejection fraction, or HFrEF) or a strong heart with poor heart relaxation (heart failure with preserved ejection fraction or HFpEF). Ejection fraction (EF) measures the amount of blood the left ventricle pumps out with each contraction. People with a healthy heart have an EF of about 60%, while people with heart failure have a reduced ejection fraction with EF 40% (HFrEF), a mildly reduced ejection fraction with EF at 40-49%, or a preserved ejection fraction with EF 50% (HFpEF). […] Medical providers often order an echocardiogram, or echo to determine the strength of the heart. An echocardiogram is an ultrasound of the heart that measures the ejection fraction (EF), wall thickness, and the flow of blood through valves in your heart.

• #36 Diagnosis of Heart Failure in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1201/p2145.html

  Heart failure is a common, progressive, complex clinical syndrome with high morbidity and mortality. The evaluation of symptomatic patients with suspected heart failure is directed at confirming the diagnosis, determining the cause, identifying concomitant illnesses, establishing the severity of heart failure, and guiding therapy. The initial evaluation should include a focused history and physical examination, a chest radiograph, and an electrocardiogram. The presence of heart failure can be confirmed by an echocardiogram. Heart failure is highly unlikely in the absence of dyspnea and an abnormal chest radiograph or electrocardiogram. Patients with confirmed heart failure should undergo additional testing, including a more detailed history and physical examination; a complete blood count; blood glucose measurement; liver function tests; serum electrolyte, blood urea nitrogen, and creatinine measurements; lipid panel; urinalysis; and thyroid-stimulating hormone level. The initial evaluation of patients with suspected heart failure should include a focused history and physical examination, an ECG, and a chest radiograph. An echocardiogram can confirm the diagnosis. Heart failure can be ruled in if jugular venous distention, displacement of the apical pulsation, or a gallop rhythm is present. Absence of dyspnea or a normal ECG and chest radiograph make the diagnosis of heart failure highly unlikely. Heart failure is a clinical diagnosis, and no single test can establish its presence or absence. In patients with this condition, the most frequent clinical findings are related to decreased exercise tolerance or fluid retention. Decreased exercise tolerance typically presents as dyspnea or, much less commonly, fatigue on exertion. Fluid retention results in orthopnea, rales, elevated jugular venous pressure, dependent edema, and the typical radiographic findings of cardiomegaly, pulmonary edema, and pleural effusion. Nearly all patients with heart failure present with dyspnea. The absence of dyspnea makes heart failure highly unlikely (sensitivity: greater than 95 percent), and other explanations for the patients symptoms should be sought first. A chest radiograph and an electrocardiogram should be obtained in patients with dyspnea and suspected heart failure. A normal chest radiograph slightly decreases the probability of heart failure and helps identify pulmonary causes of dyspnea. A normal electrocardiogram makes heart failure unlikely (sensitivity: 94 percent). If both the electrocardiogram and chest radiograph are normal, heart failure is highly unlikely (sensitivity: 95 percent or greater), and other causes should be considered. Heart failure is strongly suggested by the presence of cardiomegaly or pulmonary vascular congestion on the chest radiograph. The echocardiogram is the diagnostic standard for identifying both systolic and diastolic heart failure. The diagnosis of diastolic dysfunction is problematic. Diagnostic criteria for this type of heart failure are poorly defined, diastolic dysfunction often is present in patients who also have left ventricular systolic dysfunction, and most patients with diastolic dysfunction have other conditions that could explain their symptoms. Currently, Doppler echocardiography is the primary tool for identifying abnormal diastolic function, including diminished early diastolic filling and reduced ventricular compliance associated with diastolic dysfunction. The evaluation of symptomatic patients with suspected heart failure is directed at confirming the presence of heart failure, determining the cause, identifying comorbid illnesses, establishing the severity of heart failure, and guiding therapy.

• #37 Heart failure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148

  This test uses magnetic fields and radio waves to create detailed images of the heart. […] This test helps spot blockages in the heart arteries. […] In this test, a healthcare professional removes very small pieces of the heart muscle for examination. […] During or after testing for heart failure, your healthcare professional may tell you the stage of disease. […] Staging helps determine the most appropriate treatment. […] This system groups heart failure into four categories by number. […] Healthcare professionals often use the classification systems together to help decide the most appropriate treatment options.

• #38 Heart Failure: Diagnosis, Management and Utilization

  https://www.mdpi.com/2077-0383/5/7/62

  Multiple biomarkers have been classified depending on their putative functional impact on cardiac myocytes and the resulting pathophysiological changes in patients with HF and include (a) myocyte stretch biomarkers; (b) myocyte necrosis biomarkers; (c) systemic inflammation biomarkers; (d) oxidative stress biomarkers; (e) extracellular matrix turnover biomarkers; (f) neuro-hormone biomarkers; and (g) biomarkers of extra-cardiac processes, such as renal function. […] Other diagnostic tests for HF include chest X-ray, transthoracic echocardiography (TTE), computerized tomography (CT) scans and magnetic resonance imaging (MRI). […] Routine repeat assessment of ventricular function via TTE is desired when a patient presents with ADHF, but in the absence of altering clinical status or a change in treatment, intervention is not indicated.

• #39 Heart failure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148

  To diagnose heart failure, your healthcare professional examines you and asks questions about your symptoms and medical history. […] Your care professional listens to your lungs and heart with a device called a stethoscope. […] Tests that may be done to diagnose heart failure may include: […] Blood tests can help diagnose diseases that can affect the heart. […] X-ray images can show the condition of the lungs and heart. […] This quick and painless test records the electrical signals in the heart. […] Sound waves create images of the beating heart. […] Ejection fraction is a measurement of the percentage of blood leaving your heart each time it squeezes. […] These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored. […] This test uses X-rays to create cross-sectional images of the heart.

• #40 Heart Failure – Diagnosis | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/heart-failure/diagnosis

  If your ejection fraction is somewhere in between 41% to 49%, you may be diagnosed with heart failure with borderline ejection fraction. […] Other imaging tests show how well your heart is working, such as a cardiac CT scan, cardiac MRI, or nuclear heart scan. […] Tests for your hearts electrical activity may also be necessary. […] A stress test measures how much exercise your body can handle and how well it works during physical activity.

• #41 Diagnosis of Heart Failure | Trinity Health System

  https://www.trinityhealthofne.org/services/heart-vascular-care/heart-failure-program/diagnosis-of-heart-failure

  Heart failure is a complex condition that may have many causes. Diagnosis includes tests for the existence of heart failure, followed by tests to evaluate the cause of the heart failure. […] Blood tests can measure several things related to heart failure, such as sodium and potassium levels (electrolytes), creatinine (a measure of kidney function), albumin (a type of protein) and other tests to aid in the diagnosis of heart failure. […] Cardiac MRI; a test that uses a strong magnetic field and radiofrequencies to image the heart, blood vessels and assess the function of the heart. […] Cardiac Stress Test – or exercise stress test; a non-invasive test utilizing exercise equipment (treadmill or stationary bike) or medication to show how the heart works during physical activity. […] Cardiopulmonary exercise testing (CPET)- a specialized type of stress test that measures the body’s exercise ability. This helps to assess the severity of heart failure.

• #42 Heart failure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148

  This test uses magnetic fields and radio waves to create detailed images of the heart. […] This test helps spot blockages in the heart arteries. […] In this test, a healthcare professional removes very small pieces of the heart muscle for examination. […] During or after testing for heart failure, your healthcare professional may tell you the stage of disease. […] Staging helps determine the most appropriate treatment. […] This system groups heart failure into four categories by number. […] Healthcare professionals often use the classification systems together to help decide the most appropriate treatment options.

• #43 Heart Failure (Congestive Heart Failure) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430873/

  Laboratory investigations recommended in patients with HF include complete blood count (CBC), renal profile, liver enzymes, urine studies, serum B-type natriuretic peptide (BNP), and cardiac enzymes. […] An electrocardiogram (ECG) may show evidence of prior infarction, chamber enlargement, intraventricular conduction delay, or arrhythmia. […] Echocardiography is the initial modality of choice in patients with suspected HF and is a readily available bedside tool. […] Cardiac catheterization is often required for diagnosing ischemic cardiomyopathy and can be helpful in accurately evaluating intracardiac pressures. […] The goal of therapy for chronic HF is to improve symptoms and quality of life, decrease hospitalizations, and improve cardiac mortality. […] Management for the respective stages of HF is outlined by the American College of Cardiology and the American Heart Association.

• #44 New developments in the investigations and diagnosis of heart failure

  https://bjcardio.co.uk/2022/07/new-developments-in-the-investigations-and-diagnosis-of-heart-failure/

  The recommended cut-offs for NTproBNP are significantly lower in the ESC guidelines than in the National Institute for Health and Care Excellence (NICE) guidelines, as outlined in figure 1. […] For the diagnosis of HFmrEF, elevated natriuretic peptides plus other evidence of structural heart disease make the diagnosis more likely. […] The guidelines now have a modified classification for acute HF, divided into four distinct types. […] Right heart catheterisation should be considered in patients where HF is thought to be due to constrictive pericarditis, restrictive cardiomyopathy, congenital heart disease, and high output states (Class IIa recommendation). […] Right heart catheterisation may be considered in selected patients with HFpEF to confirm the diagnosis (Class IIb recommendation).

• #45 Heart failure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148

  This test uses magnetic fields and radio waves to create detailed images of the heart. […] This test helps spot blockages in the heart arteries. […] In this test, a healthcare professional removes very small pieces of the heart muscle for examination. […] During or after testing for heart failure, your healthcare professional may tell you the stage of disease. […] Staging helps determine the most appropriate treatment. […] This system groups heart failure into four categories by number. […] Healthcare professionals often use the classification systems together to help decide the most appropriate treatment options.

• #46 Understanding Heart Failure – Diagnosis and Treatment

  https://www.webmd.com/heart-disease/heart-failure/understanding-heart-failure-treatment

  Your doctor may also do more invasive tests, such as cardiac catheterization, to directly visualize the heart’s chambers. This test can determine if coronary artery disease is present and can also measure EF. […] Myocardial biopsy. In this test, your doctor puts a small, flexible biopsy catheter into a vein in your neck or groin, and takes a small piece of your heart muscle. This test can diagnose certain types of heart muscle diseases that cause heart failure.

• #47 Heart failure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148

  This test uses magnetic fields and radio waves to create detailed images of the heart. […] This test helps spot blockages in the heart arteries. […] In this test, a healthcare professional removes very small pieces of the heart muscle for examination. […] During or after testing for heart failure, your healthcare professional may tell you the stage of disease. […] Staging helps determine the most appropriate treatment. […] This system groups heart failure into four categories by number. […] Healthcare professionals often use the classification systems together to help decide the most appropriate treatment options.

• #48 Diagnosis – Impulse Dynamics

  https://impulse-dynamics.com/heart-failure-diagnosis/

  Once you are diagnosed as living with heart failure, your healthcare provider will occasionally ask questions designed to evaluate how capable or willing you are to engage in the daily activities that healthy people of your age typically participate in. […] The two most common classification systems are the New York Heart Association (NYHA) classification which uses a symptom-based scale with four categories ranging from Class I to Class IV., and the American College of Cardiology/ American Heart Association (ACC/AHA) scale which uses a stage-based classification system using the letters from A through D. […] You should ask your physician about your classification to understand the severity of your heart failure. […] Doctors usually classify patients heart failure according to the severity of their symptoms. […] The table below describes the most commonly used classification system, the New York Heart Association (NYHA) Functional Classification. […] It places patients in one of four categories based on how much they are limited during physical activity.

• #49 Heart Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/163062-overview

  Heart failure criteria, classification, and staging. The Framingham criteria for the diagnosis of heart failure consists of the concurrent presence of either two major criteria or one major and two minor criteria. Major criteria comprise the following: Paroxysmal nocturnal dyspnea, Weight loss of 4.5 kg in 5 days in response to treatment, Neck vein distention, Rales, Acute pulmonary edema, Hepatojugular reflux, S3 gallop, Central venous pressure greater than 16 cm water, Circulation time of 25 seconds or longer, Radiographic cardiomegaly, Pulmonary edema, visceral congestion, or cardiomegaly at autopsy. Minor criteria (accepted only if they cannot be attributed to another medical condition) are as follows: Nocturnal cough, Dyspnea on ordinary exertion, A decrease in vital capacity by one third the maximal value recorded, Pleural effusion, Tachycardia (rate of 120 bpm), Hepatomegaly, Bilateral ankle edema. The New York Heart Association (NYHA) classification system categorizes heart failure on a scale of I to IV, as follows: Class I: No limitation of physical activity, Class II: Slight limitation of physical activity, Class III: Marked limitation of physical activity, Class IV: Symptoms occur even at rest; discomfort with any physical activity. The American College of Cardiology/American Heart Association (ACC/AHA) staging system is defined by the following four stages: Stage A: High risk of heart failure but no structural heart disease or symptoms of heart failure, Stage B: Structural heart disease but no symptoms of heart failure, Stage C: Structural heart disease and symptoms of heart failure, Stage D: Refractory heart failure requiring specialized interventions. Additional ACC/AHA/ and Heart Failure Society of America (HFSA) disease-staging terminology characterizes the syndrome as a continuum: „At risk for HF” for stage A: Applied to asymptomatic patients with risk factors such as diabetes or hypertension but no known cardiac changes, „Pre-HF” for stage B: Adds cardiac structural changes or elevated natriuretic peptides, still in the absence of symptoms, „Symptomatic HF” for stage C: Structural disease with current or previous symptoms, „Advanced HF” for stage D: Characterized by severe debilitating symptoms or repeated hospitalizations even with guideline-directed medical therapy (GDMT).

• #50 Heart Failure (Congestive Heart Failure) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430873/

  The treatment of HF requires a multifaceted approach involving patient education, optimal medication administration, and decreasing acute exacerbations. […] The following parameters are used to classify HF based on LVEF: HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction, HF with preserved ejection fraction (HFpEF), and HF with improved ejection fraction. […] The ACC/AHA Stages of HF are as follows: Stage A: At risk for HF. Stage B: Pre-HF. Stage C: Symptomatic HF. Stage D: Advanced HF. […] The diagnosis and classification of HF are primarily based on the presence and severity of symptoms and physical exam findings. […] The commonly used Framingham Diagnostic Criteria for Heart Failure require the presence of 2 major criteria or 1 major and 2 minor criteria to make the diagnosis.

• #51 Heart Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/163062-overview

  Heart failure criteria, classification, and staging. The Framingham criteria for the diagnosis of heart failure consists of the concurrent presence of either two major criteria or one major and two minor criteria. Major criteria comprise the following: Paroxysmal nocturnal dyspnea, Weight loss of 4.5 kg in 5 days in response to treatment, Neck vein distention, Rales, Acute pulmonary edema, Hepatojugular reflux, S3 gallop, Central venous pressure greater than 16 cm water, Circulation time of 25 seconds or longer, Radiographic cardiomegaly, Pulmonary edema, visceral congestion, or cardiomegaly at autopsy. Minor criteria (accepted only if they cannot be attributed to another medical condition) are as follows: Nocturnal cough, Dyspnea on ordinary exertion, A decrease in vital capacity by one third the maximal value recorded, Pleural effusion, Tachycardia (rate of 120 bpm), Hepatomegaly, Bilateral ankle edema. The New York Heart Association (NYHA) classification system categorizes heart failure on a scale of I to IV, as follows: Class I: No limitation of physical activity, Class II: Slight limitation of physical activity, Class III: Marked limitation of physical activity, Class IV: Symptoms occur even at rest; discomfort with any physical activity. The American College of Cardiology/American Heart Association (ACC/AHA) staging system is defined by the following four stages: Stage A: High risk of heart failure but no structural heart disease or symptoms of heart failure, Stage B: Structural heart disease but no symptoms of heart failure, Stage C: Structural heart disease and symptoms of heart failure, Stage D: Refractory heart failure requiring specialized interventions. Additional ACC/AHA/ and Heart Failure Society of America (HFSA) disease-staging terminology characterizes the syndrome as a continuum: „At risk for HF” for stage A: Applied to asymptomatic patients with risk factors such as diabetes or hypertension but no known cardiac changes, „Pre-HF” for stage B: Adds cardiac structural changes or elevated natriuretic peptides, still in the absence of symptoms, „Symptomatic HF” for stage C: Structural disease with current or previous symptoms, „Advanced HF” for stage D: Characterized by severe debilitating symptoms or repeated hospitalizations even with guideline-directed medical therapy (GDMT).

• #52 Heart Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/163062-overview

  Heart failure criteria, classification, and staging. The Framingham criteria for the diagnosis of heart failure consists of the concurrent presence of either two major criteria or one major and two minor criteria. Major criteria comprise the following: Paroxysmal nocturnal dyspnea, Weight loss of 4.5 kg in 5 days in response to treatment, Neck vein distention, Rales, Acute pulmonary edema, Hepatojugular reflux, S3 gallop, Central venous pressure greater than 16 cm water, Circulation time of 25 seconds or longer, Radiographic cardiomegaly, Pulmonary edema, visceral congestion, or cardiomegaly at autopsy. Minor criteria (accepted only if they cannot be attributed to another medical condition) are as follows: Nocturnal cough, Dyspnea on ordinary exertion, A decrease in vital capacity by one third the maximal value recorded, Pleural effusion, Tachycardia (rate of 120 bpm), Hepatomegaly, Bilateral ankle edema. The New York Heart Association (NYHA) classification system categorizes heart failure on a scale of I to IV, as follows: Class I: No limitation of physical activity, Class II: Slight limitation of physical activity, Class III: Marked limitation of physical activity, Class IV: Symptoms occur even at rest; discomfort with any physical activity. The American College of Cardiology/American Heart Association (ACC/AHA) staging system is defined by the following four stages: Stage A: High risk of heart failure but no structural heart disease or symptoms of heart failure, Stage B: Structural heart disease but no symptoms of heart failure, Stage C: Structural heart disease and symptoms of heart failure, Stage D: Refractory heart failure requiring specialized interventions. Additional ACC/AHA/ and Heart Failure Society of America (HFSA) disease-staging terminology characterizes the syndrome as a continuum: „At risk for HF” for stage A: Applied to asymptomatic patients with risk factors such as diabetes or hypertension but no known cardiac changes, „Pre-HF” for stage B: Adds cardiac structural changes or elevated natriuretic peptides, still in the absence of symptoms, „Symptomatic HF” for stage C: Structural disease with current or previous symptoms, „Advanced HF” for stage D: Characterized by severe debilitating symptoms or repeated hospitalizations even with guideline-directed medical therapy (GDMT).

• #53 Heart Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/163062-overview

  Heart failure criteria, classification, and staging. The Framingham criteria for the diagnosis of heart failure consists of the concurrent presence of either two major criteria or one major and two minor criteria. Major criteria comprise the following: Paroxysmal nocturnal dyspnea, Weight loss of 4.5 kg in 5 days in response to treatment, Neck vein distention, Rales, Acute pulmonary edema, Hepatojugular reflux, S3 gallop, Central venous pressure greater than 16 cm water, Circulation time of 25 seconds or longer, Radiographic cardiomegaly, Pulmonary edema, visceral congestion, or cardiomegaly at autopsy. Minor criteria (accepted only if they cannot be attributed to another medical condition) are as follows: Nocturnal cough, Dyspnea on ordinary exertion, A decrease in vital capacity by one third the maximal value recorded, Pleural effusion, Tachycardia (rate of 120 bpm), Hepatomegaly, Bilateral ankle edema. The New York Heart Association (NYHA) classification system categorizes heart failure on a scale of I to IV, as follows: Class I: No limitation of physical activity, Class II: Slight limitation of physical activity, Class III: Marked limitation of physical activity, Class IV: Symptoms occur even at rest; discomfort with any physical activity. The American College of Cardiology/American Heart Association (ACC/AHA) staging system is defined by the following four stages: Stage A: High risk of heart failure but no structural heart disease or symptoms of heart failure, Stage B: Structural heart disease but no symptoms of heart failure, Stage C: Structural heart disease and symptoms of heart failure, Stage D: Refractory heart failure requiring specialized interventions. Additional ACC/AHA/ and Heart Failure Society of America (HFSA) disease-staging terminology characterizes the syndrome as a continuum: „At risk for HF” for stage A: Applied to asymptomatic patients with risk factors such as diabetes or hypertension but no known cardiac changes, „Pre-HF” for stage B: Adds cardiac structural changes or elevated natriuretic peptides, still in the absence of symptoms, „Symptomatic HF” for stage C: Structural disease with current or previous symptoms, „Advanced HF” for stage D: Characterized by severe debilitating symptoms or repeated hospitalizations even with guideline-directed medical therapy (GDMT).

• #54 Diagnosing heart failure with preserved ejection fraction (HFpEF) – Ultromics

  https://www.ultromics.com/articles/diagnosing-heart-failure-with-preserved-ejection-fraction-hfpef

  The sensitivity, however, varies substantially for this approach, ranging from 25% to 80%. […] Various parameters including clinical (patient history and physical examination), biochemical (serum BNP level), hemodynamic, and radiographic data are all utilized to reach a diagnosis, given the complexity of HFpEF. […] Scoring criteria including the H2FPEF score and HFA-PEFF scores can assist in diagnosis but are not fully validated. […] A complete physical exam should be performed on all patients with suspected heart failure, alongside a review of medical history to look for comorbidities and risk factors that are strongly linked to HFpEF. […] Several established criteria for the diagnosis of heart failure based on clinical symptoms are available. One example is the Framingham criteria, which base the diagnosis on the presence of major symptoms (such as nocturnal dyspnea and orthopnea, among others) as well as minor symptoms (such as edema of the extremities and exertional dyspnea, among others).

• #55 Heart Failure Differential Diagnoses

  https://emedicine.medscape.com/article/163062-differential

  Many classes of disorders can result in increased cardiac demand or impaired cardiac function. Cardiac causes include arrhythmias (tachycardia or bradycardia), structural heart disease, and myocardial dysfunction (systolic or diastolic). Noncardiac causes include processes that increase the preload (volume overload), increase the afterload (hypertension), reduce the oxygen-carrying capacity of the blood (anemia), or increase demand (sepsis). For example, renal failure can result in heart failure due to fluid retention and anemia. Lymphatic obstruction and venous obstruction syndromes can also cause edema-forming states, and obesity-hypoventilation syndrome (OHS) can lead to right-sided heart failure with right ventricular hypertrophy. […] Diastolic heart failure may be the most common form of heart failure in the US population. Alterations in ventricular-arterial coupling appear to have a key role in impaired hemodynamic response to exercise, but the diagnosis of diastolic heart failure cannot be excluded even in the presence of normal diastolic function at rest.

• #56 Heart Failure Differential Diagnoses

  https://emedicine.medscape.com/article/163062-differential

  Heart failure should also be differentiated from the pulmonary edema that is associated with injury to the alveolar-capillary membrane caused by diverse etiologies (ie, noncardiogenic pulmonary edema, adult respiratory distress syndrome [ARDS]). Increased capillary permeability is observed in trauma, hemorrhagic shock, sepsis, respiratory infections, administration of various drugs, and ingestion of toxins (eg, heroin, cocaine, toxic gases). With the advent of natriuretic peptide testing, differentiating cardiac from noncardiac causes of pulmonary edema has improved. […] Several features may differentiate cardiogenic from noncardiogenic pulmonary edema. In heart failure, a history of an acute cardiac event or of progressive symptoms of heart failure is usually present. The physical examination may yield clues to acute heart failure. Findings such as an S3 gallop and elevated jugular venous pulsation are highly specific for acute heart failure, but their low sensitivity makes them less-than-ideal screening tools.

• #57 Diagnosis and Evaluation of Heart Failure | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0615/p1161.html

  Heart failure is a common clinical syndrome characterized by dyspnea, fatigue, and signs of volume overload, which may include peripheral edema and pulmonary rales. Heart failure has high morbidity and mortality rates, especially in older persons. The initial evaluation includes a history and physical examination, chest radiography, electrocardiography, and laboratory assessment to identify causes or precipitating factors. A displaced cardiac apex, a third heart sound, and chest radiography findings of venous congestion or interstitial edema are useful in identifying heart failure. There is no single diagnostic test for heart failure; therefore, it remains a clinical diagnosis requiring a history, physical examination, and laboratory testing. Appropriate diagnosis and therapy for heart failure are important given the poor prognosis. Echocardiography is the diagnostic standard to confirm systolic or diastolic heart failure through assessment of left ventricular ejection fraction. Evaluation for ischemic heart disease is warranted in patients with heart failure, especially if angina is present, given that coronary artery disease is the most common cause of heart failure.

• #58 Heart failure: Clinical manifestations and diagnosis in adults – UpToDate

  https://www.uptodate.com/contents/heart-failure-clinical-manifestations-and-diagnosis-in-adults

  Heart failure: Clinical manifestations and diagnosis in adults […] The initial evaluation of the patient with suspected HF will be reviewed here. […] There is no single, noninvasive diagnostic test that serves as a gold standard for HF, since it is largely a clinical diagnosis based upon a careful history, physical examination, laboratory and imaging data. […] The clinical diagnosis of HF is limited to patients with current or prior symptoms of HF (American College of Cardiology/American Heart Association [ACC/AHA] stages C and D HF) and excludes patients with stage A (at high risk for HF but without structural heart disease or symptoms of HF) or stage B HF (structural heart disease but no symptoms or signs of HF). […] HF is caused by a number of conditions, including LV dysfunction, RV dysfunction, valvular heart disease, pericardial disease, obstructive lesions in the heart or great vessels, or high-output HF.

• #59 Heart failure – Wikipedia

  https://en.wikipedia.org/wiki/Heart_failure

  Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart’s ability to fill with and pump blood. […] Diagnosis is based on symptoms, physical findings, and echocardiography. […] The European Society of Cardiology defines the diagnosis of heart failure as symptoms and signs consistent with heart failure in combination with „objective evidence of cardiac structural or functional abnormalities”. […] The AHA/ACC/HFSA defines heart failure as symptoms and signs consistent with heart failure in combination with shown „structural and functional alterations of the heart as the underlying cause for the clinical presentation”, for HFmrEF and HFpEF specifically requiring „evidence of spontaneous or provokable increased left ventricle filling pressures”.

• #60 Heart failure learning module 2: diagnosis – The British Journal of Cardiology

  https://bjcardio.co.uk/2024/05/heart-failure-learning-module-2-diagnosis-2/

  Approximately 10-20% of patients with a diagnosis of HF at discharge from hospital initially receive treatment for something else, such as chronic obstructive pulmonary disease (COPD). As many as 16% of patients over the age of 65 presenting with breathlessness to their general practitioner (GP) may have HF as the cause. […] Heart failure (HF) is a syndrome and not a diagnosis. Once a patient has been identified as having the HF syndrome, a cause must be sought. For example, in the majority of patients with HF and a reduced ejection fraction (HFrEF), the underlying cause will be ischaemic heart disease (IHD). […] The signs and symptoms of HF are common and non-specific; misdiagnosis and under-diagnosis are common. […] A patient can be said to have the HF syndrome if they meet all of the following criteria: Typical symptoms and signs; Evidence of cardiac dysfunction raised serum natriuretic peptide (NP) concentration; Structural and/or functional abnormalities of the heart detected on imaging.

• #61 About Heart Failure | Heart Disease | CDC

  https://www.cdc.gov/heart-disease/about/heart-failure.html

  Heart failure happens when the heart cannot pump enough blood and oxygen to support other organs in your body. […] Early diagnosis and treatment can improve quality and length of life for people who have heart failure. […] People with heart failure also track their symptoms each day so that they can discuss these symptoms with their health care team.

• #62 Types of Heart Failure and Diagnosis | HFSA

  https://hfsa.org/types-heart-failure-and-diagnosis

  In order to determine the best course of therapy, physicians often assess the stage of heart failure (HF) as well as the patients functional status. […] Heart failure is also classified according to the severity of a patients self-reported symptoms using the New York Heart Association (NYHA) functional classification system.

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