Assessment
ÎÎA thorough history and physical examination should be obtained/
performed in patients presenting with HF to identify cardiac and
noncardiac disorders or behaviors that might cause or accelerate the
development or progression of HF. (I-C)
ÎÎIn patients with idiopathic dilated cardiomyopathy (DCM), a
3-generational family history should be obtained to aid in establishing
the diagnosis of familial DCM. (I-C)
ÎÎVolume status and vital signs should be assessed at each patient
encounter. This includes serial assessment of weight, as well as
estimates of jugular venous pressure and the presence of peripheral
edema or orthopnea. (I-B)
ÎÎValidated multivariable risk scores can be useful to estimate
subsequent risk of mortality in ambulatory or hospitalized patients
with HF. (IIa-B)
Table 3. History and Physical Examination in HF
History
Comments
Potential clues suggesting etiology
of HF
A careful family history may identify an
underlying familial cardiomyopathy in patients
with idiopathic DCM. Other etiologies should be
considered as well.
Duration of illness
A patient with recent-onset systolic HF may
recover over time.
Severity and triggers of dyspnea
and fatigue, presence of chest pain,
exercise capacity, physical activity,
sexual activity
To determine NYHA class; identify potential
symptoms of coronary ischemia.
Anorexia and early satiety, weight
loss
Gastrointestinal symptoms are common in
patients with HF. Cardiac cachexia is associated
with adverse prognosis.
Weight gain
Rapid weight gain suggests volume overload.
Palpitations, (pre)syncope, ICD
shocks
Palpitations may be indications of paroxysmal
AF or ventricular tachycardia. ICD shocks are
associated with adverse prognosis.
Symptoms suggesting transient
Affects consideration of the need for
ischemic attack or thromboembolism anticoagulation.
Development of peripheral edema
or ascites
Suggests volume overload.
Disordered breathing at night, sleep
problems
Treatment for sleep apnea may improve cardiac
function and decrease pulmonary hypertension.
Recent or frequent prior
hospitalizations for HF
Associated with adverse prognosis.
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