DX Of HF

New York Heart Association functional classification system

• CLASS I - No SSX with ordinary physical activity

• CLASS II - Moderate activity ➔ SSX but comfortable at rest

• CLASS III - Normal activity ➔ SSX and comfortable only at rest

• CLASS IV - Bed bound with sx at rest (life expectancy <1yr) heart transplant only option

AHA classification

• Stage A - High risk d/t pre-existing condition but no structural dz or SSX

• Stage B - Structural dz but no SSX (CLASS I)

• Stage C - Structural damage with SSX (erbody from NY)

• Stage D - End stage HF (CLASS IV)

DX

• ECHO (trans-thoracic) is gold standard

  • Shows reduced EF, diastolic dysfunction, valvular dz, atrial dilation

  • Left heart cath to determine if ischemic in nature

• ↑ NT-pro BNP/BNP > 500, ANP

• ↓ ESR (bad CHF ➔ ↓ ESR... really bad CHF ➔ ↓↓ ESR)

• CXR

  • Cardiomegaly

  • Prominent pulmonary vessels with perihilar edema ➔ bat wing

  • Septal/Kerley B lines: pulmonary edema ➔ visible septa

  • Pleural effusions

  • Circulatory congestion ➔ ↑ pulmonary vessel visibility in upper lobes (cephalization)

  • Peribronchial cuffing - fluid around bronchi

• EKG is nonspecific but likely shows LVH, P-wave abnormalities, old infarct, bundle branch blocks