Step One : History |
Step Two : Physical Examination |
Step Three : Diagnostic Tests |
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1 . Complete a thorough history and access current symptoms such as :
• Dyspnea
• Fatigue
• Decreased exercise tolerance
• Fluid retention
• Chest pain
• Disturbed breathing while sleeping
• Orthopnea
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1 . Assessment of functional status :
• Inquire about the type , severity , and duration of symptoms that occur during activities of daily living
• Ask patient to describe activities that he or she would like to do but can no longer perform
2 . At each visit , check :
• Vital signs with orthostatic blood pressure
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1 . It is necessary to identify the following :
• Appropriate treatment
• Prognosis
• Etiologic factors
• Cardiac dysfunction
2 . Patients with HF should have a measurement of their left ventricular systolic function / ejection fraction ( LVEF ): two-dimensional echocardiogram coupled with Doppler flow
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2 . A complete medical history is vital in identifying disorders that may accelerate the progression of HF , which include :
• Hypertension
• Diabetes
• Valvular heart disease
• Coronary or peripheral vascular disease
• Arrhythmia
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changes
• Weight , calculation of body mass index
( BMI )
3 . Document the presence or absence of the following : a ) Auscultation of the heart :
• Tachycardia
• Third heart sound , S3 gallop
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studies
3 . Other testing to determine the severity of cardiac abnormality includes :
• Chest radiograph
• Electrocardiogram
• Coronary arteriography
• Exercise testing
• Stress testing
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3 . Complete a thorough family history that includes the identification of : a ) Familial disposition to atherosclerotic disease :
• Myocardial infarction
• Stroke
• Peripheral arterial disease b ) Relatives with :
• Sudden cardiac death
• Conduction system disease ( need pacemaker )
• Arrhythmias
• Cardiomyopathy ( unexplained HF )
• Skeletal myopathies
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• Murmur b ) Auscultation of the lungs :
• Wheezing
• Rales c ) Neck :
• Degree of jugular venous distension d ) Extremities :
• Peripheral edema not due to venous insufficiency
• Pulses
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Laboratory Tests
Laboratory testing may reveal disorders or conditions that can lead to or exacerbate HF .
The initial evaluation of a patient with HF should include :
• Complete blood count
• Urinalysis
• Serum electrolytes ( including magnesium and calcium )
• Fasting lipid profile ( total cholesterol , LDL ,
HDL , and triglycerides )
• Thyroid function tests ( especially thyroidstimulating hormone )
• Fasting complete metabolic panel ( including
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4 . Complete a thorough review of social history :
• Tobacco use
• Alcohol consumption
• Illicit drug use
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renal and hepatic function )
• Glycohemoglobin
• BNP or NT-pro BNP - can be helpful but should not be used in isolation
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