It is of utmost importance that a diagnosis should be established – and appropriate treatment initiated as soon as possible – in patients presenting with signs and symptoms of acute heart failure. In fact, it is recommended that diagnosis and identification of precipitants should occur in parallel with treatment (Shah et al., 2017). Since the symptoms and signs may be nonspecific or not sensitive, the diagnosis of acute heart failure must preferably be confirmed by the following investigations (Ponikowski et al., 2016):
The following laboratory tests should be carried out:
An algorithm for the diagnosis of heart failure (HF) in the non-acute setting is shown in Figure 8.
A recent pilot study explored whether a lung and cardiac ultrasound protocol could aid in the diagnosis of acute heart failure. The scans were carried out by an experienced emergency physician, and a positive result was considered to be the identification of B+ lines in both anterosuperior lung zones, plus a left ventricular ejection fraction less than 45%. Tested on 99 patients, the sensitivity was 25% (95% CI 14–41%), the specificity 100% (95% CI 94–100%). The protocol took under 2 minutes to perform on average, leading the investigators to conclude that it may represent an important screening tool for rapid assessment (Russell & Ehrman, 2017).