Workup- Does the patient presenting to ED with SOB has heart failure?

LHF: Triad of DOE, Orthopnea, PND = Classic symptoms.

RHF: Pedal edema, Ascites/HSM, JVD

signs: Displaced PMI, S3, Crackles, Abdominal pain

Investigations

Non diagnostic: CXR, ECG. So need to do

Screening: BNP for vol overload.

Confirm: Echo. EF <50- Systolic dysfxn (Ischaemia). EF>55: Dia HF ie HF with preserved EF

Left heart cath: to distinguish ISCHAEMIC vrs NON-Ischaemic

Rx

1. NYHA I:    BB + ACE/ARB
2. NYHAII:   BB + ACE/ARB + Loop diuretics
3. NYHA III: BB + ACE/ARB + Loop diuretics + ISDN-Hydralazine /Sironolactone
4. NYHA IV: BB + ACE/ARB + Loop diuretics + ISDN-Hydralazine /Sironolactone + Inotropes (Dobutamine /) for Assisted device/transplant (AICD if EF <35% even if not level IV))

If ischaemic: Added Aspirin and statins

Smoking caesation

Fluid < 2L/day

Nacl <2g/day

Rx of acute excercabation

CXR & BNP to see if vol overload: If neg then not HF

ECG & Trop: to rule out  STEMI- > MONABASH- CATH

Confirmed CHF then if above 

Lasix

Morphine

Nitrates

Oxygen

Position 

Review to find out what caused the exercabation eg fluid, salt, ischaemia?