Fast Five Quiz: Test Your Knowledge on Key Aspects of Heart Failure

Yasmine S. Ali, MD, MSCI

Disclosures

February 07, 2020

A screening ECG is reasonable in patients with symptoms suggestive of heart failure. The presence of left atrial enlargement and LV hypertrophy is sensitive (although nonspecific) for chronic LV dysfunction. ECG findings are unlikely to be completely normal in the presence of heart failure; therefore, an alternative diagnosis should be sought in such cases.

Doppler echocardiography, along with 2-D echocardiography, may play a valuable role in determining diastolic function and in establishing the diagnosis of diastolic heart failure. Approximately 30%-40% of patients presenting with heart failure have normal systolic function but abnormal diastolic relaxation. The primary finding to differentiate diastolic heart failure is the presence of a normal ejection fraction; however, note that findings of diastolic dysfunction are common in the elderly and may not be associated with clinical heart failure. Because the therapy for this condition is distinctly different from that for systolic dysfunction, establishing the appropriate etiology and diagnosis is essential.

Careful evaluation of the patient's history and physical examination (including signs of congestion, such as jugular venous distention) can provide important information about the underlying cardiac abnormality in heart failure. However, other studies and/or tests may be necessary to identify structural abnormalities or conditions that can lead to or exacerbate heart failure. Endomyocardial biopsy is indicated only when a specific diagnosis is suspected that would influence therapy in patients presenting with heart failure.

BUN and creatinine levels can be within reference ranges in patients with mild-to-moderate heart failure and normal renal function, although BUN levels and BUN/creatinine ratios may be elevated.

For more on the workup of heart failure, read here.

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