Cargando…

Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review

Heart failure is a common presentation to the emergency department (ED), which can be confused with other clinical conditions. This review provides an evidence-based summary of the current ED evaluation of heart failure. Acute heart failure is the gradual or rapid decompensation of heart failure, re...

Descripción completa

Detalles Bibliográficos
Autores principales: Long, Brit, Koyfman, Alex, Gottlieb, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6860389/
https://www.ncbi.nlm.nih.gov/pubmed/31738714
http://dx.doi.org/10.5811/westjem.2019.9.43732
_version_ 1783471227318304768
author Long, Brit
Koyfman, Alex
Gottlieb, Michael
author_facet Long, Brit
Koyfman, Alex
Gottlieb, Michael
author_sort Long, Brit
collection PubMed
description Heart failure is a common presentation to the emergency department (ED), which can be confused with other clinical conditions. This review provides an evidence-based summary of the current ED evaluation of heart failure. Acute heart failure is the gradual or rapid decompensation of heart failure, resulting from either fluid overload or maldistribution. Typical symptoms can include dyspnea, orthopnea, or systemic edema. The physical examination may reveal pulmonary rales, an S3 heart sound, or extremity edema. However, physical examination findings are often not sensitive or specific. ED assessments may include electrocardiogram, complete blood count, basic metabolic profile, liver function tests, troponin, brain natriuretic peptide, and a chest radiograph. While often used, natriuretic peptides do not significantly change ED treatment, mortality, or readmission rates, although they may decrease hospital length of stay and total cost. Chest radiograph findings are not definitive, and several other conditions may mimic radiograph findings. A more reliable modality is point-of-care ultrasound, which can facilitate the diagnosis by assessing for B-lines, cardiac function, and inferior vena cava size. These modalities, combined with clinical assessment and gestalt, are recommended.
format Online
Article
Text
id pubmed-6860389
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Department of Emergency Medicine, University of California, Irvine School of Medicine
record_format MEDLINE/PubMed
spelling pubmed-68603892019-11-25 Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review Long, Brit Koyfman, Alex Gottlieb, Michael West J Emerg Med Critical Care Heart failure is a common presentation to the emergency department (ED), which can be confused with other clinical conditions. This review provides an evidence-based summary of the current ED evaluation of heart failure. Acute heart failure is the gradual or rapid decompensation of heart failure, resulting from either fluid overload or maldistribution. Typical symptoms can include dyspnea, orthopnea, or systemic edema. The physical examination may reveal pulmonary rales, an S3 heart sound, or extremity edema. However, physical examination findings are often not sensitive or specific. ED assessments may include electrocardiogram, complete blood count, basic metabolic profile, liver function tests, troponin, brain natriuretic peptide, and a chest radiograph. While often used, natriuretic peptides do not significantly change ED treatment, mortality, or readmission rates, although they may decrease hospital length of stay and total cost. Chest radiograph findings are not definitive, and several other conditions may mimic radiograph findings. A more reliable modality is point-of-care ultrasound, which can facilitate the diagnosis by assessing for B-lines, cardiac function, and inferior vena cava size. These modalities, combined with clinical assessment and gestalt, are recommended. Department of Emergency Medicine, University of California, Irvine School of Medicine 2019-11 2019-10-24 /pmc/articles/PMC6860389/ /pubmed/31738714 http://dx.doi.org/10.5811/westjem.2019.9.43732 Text en Copyright: © 2019 Long et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Critical Care
Long, Brit
Koyfman, Alex
Gottlieb, Michael
Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review
title Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review
title_full Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review
title_fullStr Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review
title_full_unstemmed Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review
title_short Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review
title_sort diagnosis of acute heart failure in the emergency department: an evidence-based review
topic Critical Care
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6860389/
https://www.ncbi.nlm.nih.gov/pubmed/31738714
http://dx.doi.org/10.5811/westjem.2019.9.43732
work_keys_str_mv AT longbrit diagnosisofacuteheartfailureintheemergencydepartmentanevidencebasedreview
AT koyfmanalex diagnosisofacuteheartfailureintheemergencydepartmentanevidencebasedreview
AT gottliebmichael diagnosisofacuteheartfailureintheemergencydepartmentanevidencebasedreview