Page 255 - ACCCN's Critical Care Nursing

232 P R I N C I P L E S A N D P R A C T I C E O F C R I T I C A L C A R E

Suspected CHF
Shortness of breath
Fatigue
Oedema

Clinical history
Physical examination
Initial investigations

Pulse rate and rhythm
Symptoms of CHF Blood pressure
Dyspnoea Elevated JVP
Orthopnoea Cardiomegaly
PND Cardiac murmurs
Fatigue Lung crepitations
Oedema Hepatomegaly
Palpitations/syncope Oedema

Past cardiovascular
disease Electrocardiogram
Angina/MI Chest x-ray
Hypertension Other blood tests: full blood
Diabetes count, electrolytes, renal
Murmur/valvular disease function, liver function,
Cardiomyopathy thyroid function
Alcohol/tobacco use Consider BNP or
Medications N-terminal proBNP test

Clinical diagnosis of CHF

Echocardiogram

Structural diagnosis Pathophysiological diagnosis
E.g. myopathic, valvular Systolic dysfunction (LVEF <40%)
Diastolic dysfunction (LVEF >40%)

Consider specialist referral Proceed to treatment guidelines
for further investigation

BNP = B-type natriuretic peptide
JVP = jugular venous pressure
LVEF = left-ventricular ejection fraction
MI = myocardial infarction
PND = paroxysmal nocturnal dyspnoea
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FIGURE 10.11 Diagnostic algorithm for CHF. Courtesy National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand.