• Exercise intolerance

• Nocturia and/or polyuria

• Hemoptysis

• Abdominal pain

• Mental status changes

• Lethargy Signs

• Pulmonary rales

• Pulmonary edema

• Pleural effusion

• Cheyne-Stokes respiration

• Tachycardia

• Cardiomegaly

• Peripheral edema (e.g., pedal edema, which is swelling of feet and ankles)

• Jugular venous distention (JVD)

• Hepatojugular reflux (HJR)

• Hepatomegaly

• Cyanosis of the digits

• Pallor or cool extremities

Laboratory Tests

• BNP greater than 100 pg/mL (greater than 100 ng/L or 28.9 pmol/L) or N-terminal proBNP (NT-proBNP) greater than 300 pg/mL (greater than 300 ng/L or greater than 35.4 pmol/L)

• ECG: May be normal or could show numerous abnormalities including acute ST-T wave changes from myocardial ischemia, atrial fibrillation, bradycardia, and LV hypertrophy

• Serum creatinine: May be increased owing to hypoperfusion; pre-existing renal dysfunction can contribute to volume overload

• CBC: Useful to determine if HF is due to reduced oxygencarrying capacity

• CXR: Useful for detection of cardiac enlargement, pulmonary edema, and pleural effusions

• Echocardiogram: Used to assess LV size, valve function, pericardial effusion, wall motion abnormalities, and EF

BNP, B-type natriuretic peptide; CBC, complete blood cell count; CXR, chest x-ray; EF, ejection fraction;

LV, left ventricular.

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