Congestive heart failure in adults. Six considerations in systematic diagnosis

There are two key clinical questions to be answered in any patient with documented congestive heart failure. First, what is the underlying etiology? Second, what exacerbating factors are present? The ECG, the echocardiogram, and chest x-ray films may provide important diagnostic clues. The mode of presentation (acute vs chronic) is also of major importance. Attention should be paid to treatable or reversible factors, including infective endocarditis, occult aortic stenosis, recurrent pulmonary emboli, and chronic constrictive pericarditis. Finally, the possibility of unrecognized congenital heart disease (eg, atrial septal defect) should not be overlooked.