Acute heart failure

Last reviewed: 27 Dec 2022
Last updated: 11 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • breathlessness
  • peripheral oedema
  • reduced exercise tolerance
  • fatigue
  • cold extremities
  • elevated jugular venous pressure
  • risk factors
  • displaced apex beat
  • gallop rhythm (third heart sound)
Full details

Other diagnostic factors

  • nocturnal cough
  • wheezing
  • dizziness
  • confusion
  • loss of appetite
  • nocturnal ischaemic pain
  • ascites
  • central cyanosis
  • narrow pulse pressure
  • altered mental status
  • oliguria
  • delayed capillary refill time
  • pulmonary crepitations
  • dullness to percussion/decreased air entry in lung bases
Full details

Risk factors

  • previous cardiovascular disease
  • older age
  • prior episode of heart failure
  • diabetes mellitus
  • family history of ischaemic heart disease or cardiomyopathy
  • excessive alcohol intake
  • smoking
  • cardiac arrhythmias
  • history of systemic conditions associated with heart failure
  • previous chemotherapy
  • medication
  • hypertension
  • valvular heart disease
  • pericardial disease
  • myocarditis
  • excessive salt intake
  • excessive catecholamine stimulation
  • abnormal thyroid function
Full details

Diagnostic investigations

1st investigations to order

  • ECG
  • chest x-ray
  • natriuretic peptides
  • troponin
  • full blood count
  • urea, electrolytes, and creatinine
  • glucose and HbA1c
  • liver function tests
  • thyroid function tests
  • C-reactive protein
  • D-dimer
  • echocardiography
Full details

Investigations to consider

  • venous or arterial blood gas
  • blood tests screening for myocarditis
  • bedside thoracic ultrasound
Full details

Treatment algorithmPage Error | BMJ Best Practice

Sorry for the delay!

We are currently experiencing technical problems with this site.

Our technical team is working hard to resolve this, and we will be back up and running as soon as we possibly can.

Return to the home page

Log in or subscribe to access all of BMJ Best Practice