Abstract
Heart failure is a common presentation to the emergency department (ED), which can be confused with other clinical conditions. This review provides an evidence-based summary of the current ED evaluation of heart failure. Acute heart failure is the gradual or rapid decompensation of heart failure, resulting from either fluid overload or maldistribution. Typical symptoms can include dyspnea, orthopnea, or systemic edema. The physical examination may reveal pulmonary rales, an S3 heart sound, or extremity edema. However, physical examination findings are often not sensitive or specific. ED assessments may include electrocardiogram, complete blood count, basic metabolic profile, liver function tests, troponin, brain natriuretic peptide, and a chest radiograph. While often used, natriuretic peptides do not significantly change ED treatment, mortality, or readmission rates, although they may decrease hospital length of stay and total cost. Chest radiograph findings are not definitive, and several other conditions may mimic radiograph findings. A more reliable modality is point-of-care ultrasound, which can facilitate the diagnosis by assessing for B-lines, cardiac function, and inferior vena cava size. These modalities, combined with clinical assessment and gestalt, are recommended.
Highlights
Acute heart failure (AHF) is a gradual or rapid decompensation in heart failure (HF) requiring urgent management.[1,2,3,4] The condition covers a large spectrum of disease, ranging from mild exacerbations with gradual increases in edema to cardiogenic shock
Heart failure is a common presentation to the emergency department (ED), which can be confused with other clinical conditions
This review provides an evidence-based summary of the current ED evaluation of heart failure
Summary
Acute heart failure (AHF) is a gradual or rapid decompensation in heart failure (HF) requiring urgent management.[1,2,3,4] The condition covers a large spectrum of disease, ranging from mild exacerbations with gradual increases in edema to cardiogenic shock. HF affects close to six million people in the United States (U.S.) and increases in prevalence with age.[6,7,8,9,10,11] Currently, the emergency department (ED) initiates the evaluation and treatment of over 80% of patients with AHF in the U.S.12-17. As the population ages, increasing numbers of patients with HF will present to the ED for evaluation and management. Making the correct diagnosis can be challenging due to the broad differential diagnosis associated with presenting symptoms and variations in patient presentations
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More From: Western Journal of Emergency Medicine, Volume 20, Issue 6
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