Evaluation of Heart Failure Decompensation

Essential Laboratory Tests

The American Heart Association recommends measuring BNP or NT-proBNP to confirm the diagnosis of acutely decompensated heart failure, especially when there is clinical uncertainty 1, 3, 4
The American College of Cardiology suggests that cardiac troponin levels are useful for determining prognosis and severity in patients hospitalized with acute decompensation, and identifying potential ischemic etiology 3, 5
The American Family Physician recommends measuring serum electrolytes, including calcium and magnesium, urea nitrogen, serum creatinine, and glucose immediately 1, 2, 5
The American Heart Association advises that monitoring serum potassium is particularly critical because hypokalemia can cause fatal arrhythmias and increase digitalis toxicity, while hyperkalemia complicates therapy with ACE inhibitors, ARBs, and aldosterone antagonists 6

The American College of Radiology recommends that a chest radiograph be performed in all patients with acute decompensation to evaluate cardiac size, pulmonary congestion, and detect cardiac, pulmonary, or other disease that may cause or contribute to symptoms 1, 3, 7
The European Society of Cardiology suggests that a 12-lead ECG be performed initially in all patients presenting with heart failure decompensation 1, 2, 3
The American Society of Echocardiography recommends that two-dimensional echocardiography with Doppler be performed during the initial evaluation to assess ventricular function, size, wall thickness, wall motion, and valvular function 1, 3, 7

The American Heart Association recommends screening for hemochromatosis or HIV in selected patients who present with heart failure 1, 2, 3
The American College of Cardiology suggests that diagnostic tests for rheumatologic diseases, amyloidosis, or pheochromocytoma are reasonable when there is clinical suspicion of these diseases 1, 2, 3

The American Heart Association warns that BNP and NT-proBNP levels can be elevated in conditions other than heart failure, such as advanced age, renal dysfunction, atrial fibrillation, pulmonary hypertension, and acute pulmonary embolism 5
The European Society of Cardiology advises that BNP and NT-proBNP levels can be falsely low in obesity, flash pulmonary edema, and heart failure with preserved ejection fraction (HFpEF) 5
The American College of Cardiology recommends regular monitoring of renal function and electrolytes, especially after initiation or adjustment of diuretics, ACE inhibitors, ARBs, or aldosterone antagonists 1, 2, 5