How To Improve Time To Diagnosis In Acute Heart Failure — Clinical Signs And Chest X-Ray

Allen, Chris; Guha, Kaushik; Sharma, Rakesh

doi:10.15420/cfr.2015.1.2.69

Cited by 15 publications

(19 citation statements)

References 61 publications

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“…Signs of pulmonary congestion at chest radiography may even precede clinical symptoms. The relationship between the clinical diagnosis of pulmonary congestion and radiological findings has good specificity (78–99%), but low sensitivity (6–74%) (24). Furthermore, 44% of their patients did not have the diagnosis of STEMI, which makes comparison difficult.…”

Section: Discussionmentioning

confidence: 99%

Carbohydrate antigen 125 predicts pulmonary congestion in patients with ST-segment elevation myocardial infarction

Falcão

Oliveira

Cantarelli

et al. 2019

Braz J Med Biol Res

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Carbohydrate antigen 125 (CA125) has long been used as an ovarian cancer biomarker. However, because it is not specific for ovarian cells, CA125 could also be used to monitor congestion and inflammation in heart disease. Acute heart failure (HF) is used to identify patients with a worse prognosis in ST-segment elevation myocardial infarction (STEMI). We aimed to determine the association of CA125 with acute HF in STEMI and to compare CA125 with N-terminal pro brain natriuretic peptide (NTproBNP) with a cross-sectional study. At admission, patients were examined to define Killip class and then underwent coronary angioplasty. Blood samples, preferably taken in the hemodynamic ward, were centrifuged (1500 g for 15 min at ambient temperature) and stored at −80°C until biomarker assays were performed. Patients were divided into two groups according to the presence or absence of congestion. Patients in Killip class ≥II were in the congestion group and those with Killip

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Section: Discussionmentioning

confidence: 99%

Carbohydrate antigen 125 predicts pulmonary congestion in patients with ST-segment elevation myocardial infarction

Falcão

Oliveira

Cantarelli

et al. 2019

Braz J Med Biol Res

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“…The profile included males who are >70 years old and have an HF history (66%-75%) and comorbidities such as diabetes, hypertension, myocardial infarction, coronary artery disease, diabetes, atrial fibrillation, and COPD 7,12,13 .…”

Section: Clinical Profilementioning

confidence: 99%

“…However, it is not a congestion-specific indicator. Other symptoms include orthopnea, paroxysmal nocturnal dyspnea, bendopnea, cough, fatigue, abdominal bloating, anorexia, and weight change (Table 1) 4,13 . Also, asthenia and adynamia could be the clinical presentation in the elderly.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…The signs associated with elevated ventricular filling pressures are the following 2,[13][14][15] : jugular venous distention (JVD), jugular venous pressure (JVP) >10 cm H2O, orthopnea, and hepatojugular reflux. Although an infrequent finding, bendopnea is characteristically observed while bending forward when putting on shoes or tying them up.…”

Section: Physical Examinationmentioning

confidence: 99%

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Acute Left Heart Failure in the Emergency Room

Jerjes‐Sánchez

Mondragon

Lozano-Corres

et al. 2023

MRAJ

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Acute heart failure (AHF), a rapid or gradual onset of symptoms and/or signs of heart failure severe enough for the patient to seek urgent medical attention, represents a significant and growing healthcare burden. With a prevalence of approximately 1%–2% of the adult population, over 5 million Americans and 15 million Europeans, with a yearly incidence of 550,000, rising ≥ 10% among the elderly. Despite therapeutic advances in chronic heart failure, the prognosis of AHF is poor, with in-hospital mortality ranging from ~2% in hypertensive AHF up to 40-60% in patients with cardiogenic shock, which is a life-threatening state characterized by tissue hypoperfusion resulting in severe multi-organ dysfunction and death. Although no current therapeutic approach has improved mortality in this patient population, incorporating standardized, multidisciplinary shock teams may change. In addition, correct and expedited identification and management of AHF can be challenging due to the heterogenicity of its clinical presentation, precipitant factors, and comorbid conditions. Thus, clinicians involved in patient care should perform a structured diagnostic work-up, starting with high clinical suspicion, followed by key diagnostic tests, including biomarkers, lung ultrasonography, and echocardiography, allowing recognition of the different clinical and hemodynamic profiles and providing guidance to perform further tests and therapeutic interventions. This review discusses the healthcare burden of acute heart failure, highlights the importance of its expedited recognition, and details a proposed diagnostic work-up and individualized management approach in the emergency department. We also perform a concise review of current international guideline recommendations. Future research directions are also provided.

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“…There is little relation between cardiothoracic ratio (CTR) and left ventricular systolic function [7]. Not all patients with acute HF have pulmonary congestion on their CXR [8]. However, amongst patients presenting to hospital with acute myocardial infarction, worsening features of HF on the CXR are related to increasing risk of death [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of the chest X-ray in patients hospitalised for heart failure

et al. 2021

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Background Patients admitted to hospital with heart failure will have had a chest X-ray (CXR), but little is known about their prognostic significance. We aimed to report the prevalence and prognostic value of the initial chest radiograph findings in patients admitted to hospital with heart failure (acute heart failure, AHF). Methods The erect CXRs of all patients admitted with AHF between October 2012 and November 2016 were reviewed for pulmonary venous congestion, Kerley B lines, pleural effusions and alveolar oedema. Film projection (whether anterior–posterior [AP] or posterior–anterior [PA]) and cardiothoracic ratio (CTR) were also recorded. Trial registration: ISRCTN96643197 Results Of 1145 patients enrolled, 975 [median (interquartile range) age 77 (68–83) years, 61% with moderate, or worse, left ventricular systolic dysfunction, and median NT-proBNP 5047 (2337–10,945) ng/l] had an adequate initial radiograph, of which 691 (71%) were AP. The median CTR was 0.57 (IQR 0.53–0.61) in PA films and 0.60 (0.55–0.64) in AP films. Pulmonary venous congestion was present in 756 (78%) of films, Kerley B lines in 688 (71%), pleural effusions in 649 (67%) and alveolar oedema in 622 (64%). A CXR score was constructed using the above features. Increasing score was associated with increasing age, urea, NT-proBNP, and decreasing systolic blood pressure, haemoglobin and albumin; and with all-cause mortality on multivariable analysis (hazard ratio 1.10, 95% confidence intervals 1.07–1.13, p < 0.001). Conclusions Radiographic evidence of congestion on a CXR is very common in patients with AHF and is associated with other clinical measures of worse prognosis. Graphic abstract

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How To Improve Time To Diagnosis In Acute Heart Failure — Clinical Signs And Chest X-Ray

Cited by 15 publications

References 61 publications

Carbohydrate antigen 125 predicts pulmonary congestion in patients with ST-segment elevation myocardial infarction

Carbohydrate antigen 125 predicts pulmonary congestion in patients with ST-segment elevation myocardial infarction

Acute Left Heart Failure in the Emergency Room

Prognostic value of the chest X-ray in patients hospitalised for heart failure

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