0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45
Acute Heart Failure 25➣D-dimers: occasionally used to assist in dDx of pulmonary embo-
lus
➣Liver function tests: AST, ALT, LDH, direct and indirect bilirubin
elevated in congestive hepatopathy
➣TSH: hypo- or hyperthyroidism
■Basic Urine Tests
➣Proteinuria, high specific gravity, acellular casts
■Specific Diagnostic Tests
➣Chest X-ray: cardiomegaly (size and shape can assist with
dx); pulmonary vascular redistribution, interstitial pulmonary
edema (Kerley B lines, perivascular, subpleural effusion), alveo-
lar edema (“butterfly pattern”)
➣Electrocardiogram: ischemia/ infarction; evidence of LVH, prior
MI, arrhythmias
➣Echocardiogram: Cardiac function, structure, wall motion and
valvular abnormalities
■Other Tests as Appropriate
➣Radionuclide Ventriculogram (RVG; MUGA): Cardiac function,
wall motion abnormalities
➣Exercise or pharmacologic stress testing: assess myocardial
ischemia risk
➣Cardiac catheterization: define coronary anatomy, possible
interventions
differential diagnosis
■Abnormal ventricular or atrial rhythm
■Acute bronchitis/ asthma
■Pneumonia
■Sepsis
■Cardiogenic Shock
➣Other non-cardiogenic pulmonary edema (Intravenous nar-
cotics, increased intracerebral pressure, high altitude, transfu-
sion reactions, DIC)
management
What to Do First
■Check and monitor vital signs, oxygenation and ECG
■Evaluate for underlying etiology (see differential diagnosis), espe-
cially sepsis, myocardial ischemia/ infarction, cardiac mechanical
abnormalities (valvular, VSD, etc.)
■Treat underlying etiology (i.e. myocardial infarction – primary PCI,
thrombolysis)