Fast Five Quiz: Acute Heart Failure Presentation and Diagnosis

Arnold S. Baas, MD; Jeff Hsu, MD


May 12, 2020

Congestion is a common element of acute heart failure. When assessing patients for acute heart failure, history and physical examination should largely focus on the presence of congestion, which would support the diagnosis of acute heart failure. Of note, a normal chest radiograph does not exclude left ventricular congestion. Similarly, the absence of rales does not exclude left ventricular congestion.

Cough and hypoxia may be caused by left ventricular congestion. Other findings of left-ventricular congestion include dyspnea, orthopnea, and bendopnea, as well as paroxysmal nocturnal dyspnea, tachypnea, and pathologic lung auscultation (rales, crackles, wheezing). Signs and symptoms of right ventricular congestion may include increased body weight, bilateral peripheral edema, decreased urine output, abdominal pain, nausea and vomiting, jugular vein distention or positive hepatojugular reflux, ascites, hepatomegaly, and icterus.

Learn more about the clinical evaluation of patients with acute heart failure.


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