Acute heart failure

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



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

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