What are the indications for TTE?
Every patient with suspected new-onset HF (best initial imaging test to assess cardiac structure and function) [22][23]
Changes in clinical features in patients receiving treatment (monitoring)
Evaluation for device therapy
List supportive findings of TTE.
Features of heart failure
Left ventricular systolic dysfunction: assessed via LVEF [1]
HFpEF: normal (50–70%)
Borderline HFpEF: (41–49%)
HFrEF: reduced (≤ 40%)
Diastolic dysfunction [24]
Pulmonary hypertension and right ventricular dysfunction
Pericardial and/or pleural effusion [25]
Evidence of complications [24]
Cardiac dyssynchrony
Functional mitral regurgitation
Left atrial enlargement
Underlying causes, including:
Regional wall motion abnormalities in coronary artery disease
Left ventricular hypertrophy in hypertension
Flow abnormalities across heart valves in valvular disease
What is the indication of Chest x-ray?
acute, new-onset, or suspected heart failure
List findings of chest x-ray.
Changes to cardiac silhouette
Enlarged: cardiothoracic width ratio > 0.5 [26]
Boot-shaped heart on PA view: RV enlargement
Signs of pericardial effusion (e.g., water bottle heart)
X-ray findings of pulmonary congestion
Signs of concurrent heart conditions, including:
Valvular calcifications in valvular disease
Pericardial calcification in constrictive pericarditis
ECG abnormalities in CHF are common but mostly nonspecific. List common findings.
ECG signs of left ventricular hypertrophy (e.g., positive Sokolow-Lyon index)
Left axis deviation
ST-T abnormalities (e.g., ST depression)
P wave abnormalities (e.g., P mitrale)
Prolonged QTc interval
Incomplete or complete left bundle branch block
List ECG signs of concurrent heart conditions.
Ischemic changes of a previous or acute myocardial infarction (e.g., Q waves or ST elevations)
Arrhythmias (e.g., atrial fibrillation, sinus tachycardia or bradycardia)
Pericardial effusion (e.g., electrical alternans, low voltage QRS)
List additional studies that can be helpful when there is diagnostic uncertainty and to evaluate for underlying causes.
Advanced cardiac imaging (Cardiac MRI, Radionuclide ventriculography, PET myocardial perfusion imaging).
Other: Left heart catherization/ coronary angiogram, Right heart catheterization, Endomyocardial biopsy, blood pressure monitoring, ECG monitoring
Describe the Cardiac MRI.
Gold standard for assessment of ventricular volume, mass, and ejection fraction
Indications include:
Diagnostic uncertainty following echocardiography
Investigation of congenital heart disease or infiltrative processes
Determination of myocardial scar burden
Describe the radionuclide ventriculography.
used to assess LVEF and volume if other imaging modalities are inadequate or contraindicated
Describe the use of PET myocardial perfusion imagning.
alternative noninvasive workup for suspected coronary artery disease
Describe left heart catheterization or coronary angiogram.
identification and treatment of coronary artery disease
Describe the right heart catheterization.
Assessment of right heart function and pulmonary vascular resistance in patients being considered for mechanical circulatory support or transplant
Monitoring in cardiogenic shock: SvO2 will be low in decompensated heart failure.
Describe the endomyocardial biopsy.
indicated if there is ongoing diagnostic uncertainty in rapidly progressive disease or to confirm the diagnosis of infiltrative heart disease
Describe the blood pressure monitoring.
Consider in patients with suspected hypertension.
Describe the ECG monitoring.
Consider in suspected paroxysmal atrial fibrillation or other underlying arrhythmias.
In pathology, a sputum analysis of pulmonary edema patients can reveal…?
Heart failure cells (hemosiderin-containing cells).
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