From the Guidelines
The initial workup for a patient with symptoms of heart failure should include a thorough history and physical examination, electrocardiogram, chest X-ray, laboratory tests such as complete blood count, comprehensive metabolic panel, thyroid function tests, and B-type natriuretic peptide (BNP) or NT-proBNP, as well as echocardiography to assess cardiac structure and function. The initial assessment of a patient with heart failure symptoms is crucial for determining the underlying cause, severity, and guiding treatment strategies.
- A thorough history and physical examination should be performed to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of heart failure, as recommended by 1.
- The physical examination should include assessment of the patient’s volume status, orthostatic blood pressure changes, measurement of weight and height, and calculation of body mass index, as stated in 1.
- Initial laboratory evaluation should include complete blood count, urinalysis, serum electrolytes, blood urea nitrogen, serum creatinine, fasting blood glucose, lipid profile, liver function tests, and thyroid-stimulating hormone, as recommended by 1.
- A 12-lead electrocardiogram and chest radiograph (posterior-anterior and lateral) should be performed initially in all patients presenting with heart failure, as stated in 1.
- Two-dimensional echocardiography with Doppler should be performed during initial evaluation to assess left ventricular ejection fraction, left ventricular size, wall thickness, and valve function, as recommended by 1.
- Additional tests, such as stress testing or coronary angiography, may be necessary if ischemic heart disease is suspected, as stated in 1. This comprehensive approach allows for accurate diagnosis, determination of heart failure etiology, assessment of severity, and guides appropriate treatment strategies to improve symptoms and outcomes, as supported by 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Initial Workup for Heart Failure
The initial workup for a patient with symptoms of heart failure includes:
- A focused history and physical examination to confirm the diagnosis, determine the cause, and identify concomitant illnesses 2, 3, 4, 5
- A chest radiograph to assess for signs of volume overload, such as pulmonary edema or cardiomegaly 2, 3, 4
- An electrocardiogram (ECG) to evaluate for signs of ischemia, arrhythmias, or conduction abnormalities 2, 3, 4
- Laboratory tests, including a complete blood count, blood glucose measurement, liver function tests, serum electrolyte measurements, and lipid panel 2, 4
- An echocardiogram to confirm the presence of heart failure and assess left ventricular function 2, 3
Additional Testing
Additional testing may be necessary in certain cases, such as:
- Radionuclide angiography or contrast cineangiography if the echocardiogram is equivocal 2
- Serum ferritin level, human immunodeficiency virus test, antinuclear antibody assays, rheumatoid factor test, or metanephrine measurements in selected patients 2
- Evaluation for ischemic heart disease, especially if angina is present 3
Importance of Early Diagnosis
Early diagnosis and treatment of heart failure are crucial to improve outcomes and reduce morbidity and mortality 6, 5. A thorough initial workup is essential to guide therapy and improve patient outcomes.