Fast Five Quiz: Acute Heart Failure Presentation and Diagnosis

Arnold S. Baas, MD; Jeff Hsu, MD


May 12, 2020

Pulse oximetry can accurately assess the presence of hypoxemia and, therefore, the severity of acute heart failure presentations. Modest reductions in oxygen saturation may be seen in patients with mild to moderate acute heart failure, whereas those with severe heart failure may have severe oxygen desaturation, even at rest. Pulse oximetry is also beneficial for monitoring response to supplemental oxygen and other therapies.

Liver function tests can aid in the diagnosis of acute heart failure. In patients with severe acute right ventricular or left ventricular failure, frank jaundice may occur. Moreover, acute hepatic venous congestion can result in severe jaundice, with a bilirubin level as high as 15-20 mg/dL, elevation of the aspartate aminotransferase level to more than 10 times the upper reference range limit, elevation of the serum alkaline phosphatase level, and prolongation of the prothrombin time. Although clinical and laboratory findings may resemble those of viral hepatitis, the impairment of hepatic function is rapidly resolved by successful treatment of heart failure.

Rapid measurement of natriuretic peptides, including B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP), is useful for differentiating between cardiac and noncardiac causes of dyspnea and is recommended by international guidelines. Studies have found increased NT-proBNP to be the strongest independent predictor of a final diagnosis of acute heart failure.

Measurement of arterial blood gas is rarely indicated in the setting of acute heart failure. Indications include severe respiratory distress, documented hypoxemia by pulse oximetry not responsive to supplemental oxygen, and evidence of acidosis by serum chemistry findings or elevated lactate levels.

Learn more about the workup of patients with suspected acute heart failure.


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