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