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Routine blood tests like haemoglobin, creatinine, electrolytes are useful to plan treatment. More recently the blood natriuretic peptide levels have been used to assess heart failure. BNP (brain natriuretic peptide) may be increased early in left ventricular dysfunction. It is synthesized mainly by the ventricles and released early in heart failure.
The Framingham study group has come out with criteria for diagnosis of heart failure incorporating symptoms, signs, investigations and response to treatment. It is a useful criteria for the clinicians.
Major Criteria
Paroxysmal nocturnal dyspnoea Neck vein distention Rales Radiographic cardiomegaly Acute pulmonary edema S3 gallop Central venous pressure >16 cm H2O Circulation time >25 sec Hepatojugular reflux Pulmonary adema, visceral congestion, or cardiomegaly at autopsy Weight loss >4.5 kg in 5 days in response to treatment of congestive heart failure.
Minor Major
Bilateral ankle edema Nocturnal cough Dyspnoea on ordinary exertion Hepatomegaly Pleural effusion Decrease in vital capacity by one third from maximal value recorded Tachycardia (rate >120 beats/min)
Note: The diagnosis of congestive heart failure in this study required that two majoror one major and two minor criteria be present concurrently. Minor criteria were acceptable only if they could not be attributed to another medical condition.
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