Summary
Definition
History and exam
Key diagnostic factors
- age >70 years
- positive past medical history
- dyspnea
- pulmonary crepitations
- peripheral edema
- cool peripheries
- chest pain
- third heart sound (S3)
Other diagnostic factors
- fatigue and weakness or decreased exercise tolerance
- hypotension
- tachycardia
- elevated jugular venous pressure
- displaced apex beat (point of maximal impulse)
- dullness to percussion and decreased air entry in lung bases
- wheezing
- palpitations
- cough
- fever
- syncope
- murmur
- ascites
- hepatomegaly
- central cyanosis
Risk factors
- age >70 years
- prior episode of heart failure
- coronary artery disease
- hypertension
- valvular heart disease
- pericardial disease
- myocarditis
- atrial fibrillation
- diabetes mellitus
- nonadherence to medications
- excessive salt intake
- excessive catecholamine stimulation
- abnormal thyroid function
- excessive alcohol intake
Diagnostic investigations
1st investigations to order
- ECG
- chest x-ray
- Hb
- thyroid function test
- troponin
- B-type natriuretic peptide (BNP)
- echocardiography
Investigations to consider
- cardiac catheterization
- endomyocardial biopsy
- cardiac magnetic resonance (CMR)
- single-photon emission CT
- positron emission tomography with or without CT
- cardiac CT (coronary CT angiogram)
- additional biomarkers
Treatment algorithm
Contributors
Authors
Syed Wamique Yusuf, MBBS, FACC, FRCPI
Professor of Medicine
Department of Cardiology
University of Texas
MD Anderson Cancer Center
Houston
TX
Disclosures
SWY declares that he is a co-director of the American College of Cardiology (ACC) Cardiovascular Board Review Course during which he also delivers lectures.
Acknowledgements
Dr Syed Wamique Yusuf would like to gratefully acknowledge Dr Daniel Lenihan, a previous contributor to this topic.
Disclosures
DL declares that he has no competing interests.
Peer reviewers
David Whellan, MD
Assistant Professor of Medicine
Jefferson Medical College
Philadelphia
PA
Disclosures
DW declares that he has no competing interests.
Katherine C. Wu, MD
Assistant Professor of Medicine
Johns Hopkins University School of Medicine
Baltimore
MD
Disclosures
KCW declares that she has no competing interests.
Sanjay Sharma, BSc (Hons), FRCP (UK), MD
Consultant Cardiologist
King's College Hospital London
London
UK
Disclosures
SS declares that he has no competing interests.
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