Focused Assessment of the Patient with Acute Heart Failure or Decompensated Chronic Heart Failure
History Total duration of symptoms and of acute deterioration Degree of exertional breathlessness (after how many steps or stairs, on the flat or slopes or hills; see Box for NYHA functional classification) generalNew York Heart Association (NYHA) functional classification Class 1 Can manage ordinary physical activity without undue fatigue or breathlessness Class 2 Slight limitation of ordinary activity by fatigue or breathlessness Class 3 Marked limitation of ordinary activity by fatigue or breathlessness Class 4 Cannot manage any activity without fatigue or breathlessness, and may have symptoms at rest Orthopnoea or paroxysmal nocturnal dyspnoea? Is heart failure or a cardiomyopathy known? What investigations have been done? Who normally manages care? Is there a history of hypertension or coronary artery disease? Drug history including any recent change and evidence for compliance? Any change in diet, for example increase in salt intake? Examination General appearance Body mass index (cachexia?) Heart rate and blood pressure Jugular venous pressure, peripheral oedema, ascites Respiratory rate, arterial oxygen saturation, inspiratory crackles, signs of pleural effusion Murmurs, third heart sound, apex displacement |