Diagnostic Approach

Diagnosing HF requires a combination of:

• Medical history (personal and family)
• Physical examination
• Lab tests
• Imaging

Key points from history:

• Risk factors: hypertension, previous MI, valvular disease, cardiomyopathy
• Medications: May reveal precipitating drugs or inadequate HF therapy

Physical examination focuses on signs of congestion and hypoperfusion:

• Vital signs: Tachycardia, irregular rhythm, tachypnea, hypotension, narrow pulse pressure
• Neck veins: Jugular venous distension, hepatojugular reflux
• Heart: Displaced apical impulse, S3 gallop, murmurs
• Lungs: Rales, wheezing
• Extremities: Peripheral edema, cool extremities
• Abdomen: Hepatomegaly, ascites

Key diagnostic labs and imaging:

• Natriuretic peptides (BNP or NT-proBNP): Levels are significantly elevated in HF. Help differentiate cardiac from non-cardiac dyspnea.
• Echocardiography: Assesses cardiac structure and function. Used to determine LVEF anddiagnose structural abnormalities.
• Electrocardiography: Provides clues through arrhythmias, LVH, QRS duration, etc.
• Chest X-ray: Useful for pulmonary congestion, cardiomegaly and pleural effusions.
• Complete blood count: Anemia reduces oxygen delivery.
• Comprehensive metabolic panel: Assesses renal function which affects medication management.
• Iron studies: Iron deficiency is common and associated with worse outcomes.

Other tools like cardiac MRI, right heart catheterization, radionuclide ventriculography can provide additional information when needed.

No single test confirms HF – correlation of clinical presentation with natriuretic peptide levels and cardiac imaging is key. Determining LVEF also guides prognosis and selection of therapy.