Evaluation for the presence of heart failure

• CXR (see Radiology insert):
  • pulm edema,
  • pleural effusions ± cardiomegaly,
  • cephalization,
  • Kerley B-lines;
• lung U/S better than CXR (PPV & NPV 92% vs. 77%; Chest 2015;148:202)
• BNP and NT-proBNP can help exclude HF;
• Evidence of ↓ organ perfusion:
  • ↑ Cr,
  • ↓ Na,
  • abnl LFTs
• Echo (see inserts):
  • ↓ EF & ↑ chamber size → systolic dysfxn; hypertrophy,
  • abnl MV inflow,
  • abnl tissue Doppler → ? diastolic dysfxn; abnl valves or pericardium; ↑ estimated RVSP
• PA catheterization:
  • ↑ PCWP,
  • ↓ CO,
  • and ↑ SVR (in low-output failure)