Management of Heart Failure
Cardiomegaly, cardiothoracic ratio IMAGE 0.5 on an anteroposterior chest radiograph is common finding in HF patients. Pulmonary edema is marked by equalization of the caliber of blood vessels in the apex and the lung bases (cephalization of blood flow), interstitial edema (development of Kerley’s B lines, sharp linear densities of interlobular interstitial edema), and alveolar edema (central butterfly or cloudlike appearance of fluid around the hili).
Laboratory testing in a patient with a new HF diagnosis should include an electrocardiogram, complete blood count, urinalysis, serum creatinine, potassium, and albumin levels, and thyroid studies (T4, TSH). Screening evaluation for arrhythmias using Holter monitoring is not routinely warranted.
Echocardiography has become an established diagnostic test for defining the cause and severity of HF, but it remains an underutilized procedure in the primary care setting. Echocardiography should be performed on all patients suspected of having HF. This is true even in apparently well-compensated elderly patients as clinical symptoms and signs correlate poorly with cardiac function and a diagnosis of HF is less certain. A two-dimensional echocardiogram coupled with Doppler flow studies allows the physician to determine chamber dimensions, geometry, and thickness, regional wall motion abnormalities, and qualitative information about the cardiac valves. Essential for HF management, the echocardiogram also provides measurement of the LVEF.