How is acute heart failure diagnosed?

The article was professionally consulted by BSCK II Nguyen Quoc Viet - Interventional Cardiologist - Department of Medical Examination & Internal Medicine, Vinmec Danang International General Hospital.

Acute heart failure is a rapid onset or worsening of the symptoms and signs of pre-existing heart failure, which can be life-threatening. Patients should be diagnosed with acute heart failure as soon as they are admitted to the hospital and treated immediately.

Acute heart failure may occur for the first time or recur as a result of:
Acute decompensated chronic heart failure: An acute decompensation of chronic heart failure may occur when predisposing factors such as infection, uncontrolled hypertension, arrhythmia or non-compliance with medication and diet, psychological stress...
Primary cardiac dysfunction: The most common acute primary cardiac causes of heart failure Acute myocardial dysfunction includes acute myocardial dysfunction, ischemia, inflammation or toxicity, acute valvular regurgitation, and cardiac tamponade.
Driven by exogenous factors: Common in patients with chronic heart failure who have used toxic substances such as alcohol, drugs and some drugs such as NSAIDs, corticosteroids, inotropic drugs, chemotherapy causing heart toxicity.

2.1. Early diagnosis supports treatment Where possible, the diagnosis of acute heart failure should be initiated even before the patient is hospitalized and continued in the emergency department for timely identification and initiation of appropriate treatment. Early initiation of treatment has been shown to be beneficial for acute coronary syndromes, but further consideration is needed in acute heart failure.
2.2. Differential diagnosis The first step in the diagnostic criteria for acute heart failure is to exclude differential diagnoses that are easily confused with acute heart failure such as:
Respiratory infection; Severe anemia; Acute renal failure... Thanks to the immediate identification of clinical conditions and/or life-threatening precipitating factors, treatment measures are also carried out promptly and promptly.
2.3. Evaluation After Confirmed Diagnosis After acute heart failure is diagnosed, it is imperative that the physician make a clinical assessment to choose the treatment direction. Through physical and laboratory examination, the initial diagnosis of acute heart failure should be based on:
Complete history; Assess for symptoms, history of cardiovascular disease, and cardiac or noncardiac predisposing factors; Evaluate for signs of congestion and/or hypoperfusion. For patients with acute heart failure, early initiation of appropriate treatment, along with close follow-up, is very important.

The sensitivity and specificity of symptoms and signs of heart failure are often inadequate, including fluid overload, decreased cardiac output, and peripheral hypoperfusion. Therefore, the subclinical diagnosis of acute heart failure should be made after careful clinical evaluation.
3.1. Chest X-ray Although up to 20% of patients with acute heart failure have a near-normal chest X-ray, it can still be useful because of its ability to detect the most distinctive signs of heart failure. acute, namely:
Pulmonary venous congestion; Pleural effusion ; Interstitial or alveolar edema; Big heart. In addition, chest X-rays also help identify conditions that are not cardiovascular, but may cause or contribute to a patient's symptoms, such as pneumonia or a non-coagulated lung infection. However, a supine chest x-ray will be of limited value in diagnosing acute heart failure.
3.2. Electrocardiogram (ECG) Electrocardiogram ECG waves are rarely normal in patients with acute heart failure, instead having a high negative predictive value. The electrocardiogram method is also effective in identifying heart disease as well as other predisposing factors, including rapid atrial fibrillation, acute myocardial ischemia...
3.3. Emergency echocardiography This measure is mandatory only in hemodynamically disturbed patients, particularly in cardiogenic shock, and in patients with suspected life-threatening structural or functional abnormalities of the heart. , eg:
Mechanical complications; Acute valvular regurgitation; Dissecting aortic aneurysm. Differences in the effectiveness of each ultrasound indication for specific cases are:
Early echocardiography: Should be considered in all patients with first-time acute heart failure and unknown cardiac function. The optimal time is usually within 48 hours of admission. Repeat echocardiography: Only used when clinically significant deterioration, otherwise usually not needed. Bedside chest ultrasound: May be helpful in diagnosing acute heart failure through signs of interstitial edema and pleural effusion. 3.4. Biochemical tests Specialized biomarkers will be detected through a number of tests, such as:
Diuretic peptide; Arterial blood gases; Measure cardiac troponin; Creatinine, BUN and electrolytes; Evaluation of procalcitonin levels; Liver function; Thyroid stimulating hormone TSH.

In general, the criteria for the diagnosis of acute heart failure are required to be conducted as soon as possible in order to quickly provide timely treatment and avoid life-threatening risks. Therefore, not only patients who already have symptoms of heart failure, but especially middle-aged people (from 45 to 50 years old) should also undergo annual cardiovascular screening. Especially people with high blood pressure, diabetes, arrhythmia or smoking, drinking alcohol, obesity.
When choosing the Heart Failure Examination Package at the Department of Cardiology - Vinmec International General Hospital, the patient will be determined the heart failure status, the degree of heart failure, the cause of the failure as well as the associated diseases. Vinmec's highly qualified medical-physician team will directly conduct general examination, ultrasound and perform many related diagnostic tests for acute heart failure to provide appropriate treatment. for each patient.