History and exam
Key diagnostic factors
common
positive past medical history
In patients hospitalized for acute heart failure, around 75% have a history of prior heart failure.[11]
Nonadherence to medications is a precipitating factor in patients with acute on chronic heart failure.
Coronary artery disease accounts for around 50% of all patients with acute heart failure.[11][12][13][14]
A history of hypertension is present in 72% of patients in the US and 60% of patients in Europe.[11][13][14]
About 23% of patients in the US and 34% in Europe have valvular disease as an associated condition.[11][14] Both significant stenotic and regurgitant lesions can lead to heart failure.
Atrial fibrillation is present in approximately 35% of cases.[15]
Diabetes mellitus is directly related to ischemia and renal failure.
Large pericardial effusions and pericardial constriction can present with symptoms or signs of acute heart failure.
Myocarditis may also cause heart failure.
dyspnea
Dyspnea (including orthopnea or paroxysmal nocturnal dyspnea) is the predominant symptom and is present in the majority of patients with acute heart failure.[9]
pulmonary crepitations
Key finding on chest examination.[9]
cool peripheries
Due to reduced cardiac output.
uncommon
chest pain
If underlying cardiac ischemia.
third heart sound (S3)
Often difficult to hear, low intensity sound heard early in diastole.
Other diagnostic factors
common
fatigue and weakness or decreased exercise tolerance
Due to poor cardiac functioning.
hypotension
Sign of left and right heart failure.
tachycardia
Due to activation of the sympathetic nervous system or underlying arrhythmia.
elevated jugular venous pressure
Sign of right heart failure.
displaced apex beat (point of maximal impulse)
This, together with elevated jugular venous pressure, third heart sound, crepitations, and edema, suggests a diagnosis of acute heart failure.
dullness to percussion and decreased air entry in lung bases
Suggestive of pleural effusion.
wheezing
Suggests cardiac asthma.
uncommon
palpitations
If underlying arrhythmia.
cough
Due to pulmonary congestion.
syncope
Suggestive of underlying cause, such as significant aortic stenosis or pulmonary embolism.
murmur
Both significant stenotic and regurgitant lesions can lead to heart failure.
ascites
Acute heart failure is a nonhepatic cause of increased portal hypertension, which in turn causes ascites.
hepatomegaly
This may occur due to right-sided heart failure and venous congestion.
central cyanosis
Due to systemic arterial oxygen desaturation.
Use of this content is subject to our disclaimer