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Table 48.1

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