Clinical approaches to the diagnosis of acute heart failure

Predicting which patients with congestive heart failure will decompensate is often difficult, and it is often difficult to distinguish congestive heart failure from other causes of acute dyspnea. This review will focus on some of the newer tools used to diagnose acute congestive heart failure in addition to reviewing the utility of more traditional tools.

The integration of pertinent positives and negatives on a routine history, key physical findings on examination and routine noninvasive imaging offers high positive and negative predictive power for the diagnosis of acute heart failure. Measurement of B-type natriuretic peptide and N-terminal proB-type natriuretic peptide offers additional and incremental diagnostic information. Measurement of intrathoracic impedance is a novel and potentially useful tool to track absolute changes in cardiac function and total lung fluid content, and may be useful for the outpatient titration of medical therapy to minimize acute congestive heart failure decompensation.

Consistent accurate diagnosis of decompensated congestive heart failure is possible using no more than a complete history and physical examination along with routine imaging techniques. The ability to diagnose acute congestive heart failure however, is improved by using serum B-type natriuretic peptide and intrathoracic impedance, both of which offer additive and complementary diagnostic information.