Heart Failure 8: Diagnosis

Diagnosis
Framingham criteria:
A. Major criteria
1. Dispnea nocturnal paroksismal or ortopnea
2. Increased pressure vena jugularis
3. Wet Ronki not loud
4. Cardiomegali
5. Edema acute tuberculosis
6. Clop rhythm S3
7. Vein Increased pressure> 16 cm H2O
8. Refluks hepatojugular
B. Minor criteria
1. Edema ankle
2. Coughing at night
3. Dyspnea d'effort
4. Hepatomegali
5. Efusi pleura
6. Vital capacity is reduced to 1 / 3 maximum
7. Takikardi (> 120x/minute)
C. Major or Minor criteria
Decrease in body weight> 4.5 kg in 5 days after therapy.
Diagnosis excellent with 2 major criteria or 1 major criteria and 2 minor criteria must be present at the same time.

Examination support

a. Laboratory results
Calculate blood showed anemia, which is a cause of high output heart failure and as a factor exacerbate to other forms of heart disfungsi. Kidney function tests also determine whether heart failure is associated with azotemia prerenal. Electrolyte can help reveal the cause neuroendokrin activity hiponatremia. Tiroid function in elderly patients should be assessed to detect hidden tirotoksikosis or miksedema. Additional assessment on kardiomiopati dilatasi must be removed including the examination of iron content to remove hemokromatosis. Biopsy miokardium can eliminate specific causes kardiomiopati dilatasi but rarely may disclose a specific diagnosis reversibel (Tierney et al. 2002).

b. Photo Electrocardiography and chest roentgen
Electrocardiography can show aritmia that underlie aritmia or secondary, infark miokard, or changes in non-specific such as low voltage, defek conduction intraventrikuler, and changes repolarisasi non-specific. Radiografi provide information about the breast size and form of the heart shadow. The picture is kardiomegali importance. There is hypertrophy vena pulmonalis can be shown with dilatasi vena lobus up, edema perivaskuler (blood vessel boundaries become hazy), interstitial edema, and alveolar fluid. In the acute heart failure, these findings are only a few colerasion with vena pulmonalis pressure, and if there is a chronicle of failed heart, there is usually increased pressure. Effuse pleura and often occur more frequently on both sides of the tuberculosis (Tierney et al. 2002).

c. Ekokardiografi
Because patients often fail heart rudiment showed electrocardiography rest, the procedure needs to be done pencitraan for example skintigrafi perfused or ekokardiografi with dobutamin.
The most useful test is ekokardiogram. This will reveal the size and function of both the second and the second ventricle atrium. This can also detect the fusion pericardium, abnormalities valve, pirau intrakardial, and segmental wall motion abnormalities that indicates the existence of infark miokard of the antagonist with the general form of kardiomiopati dilates (Tierney et al. 2002).
Ekokardiografi is an examination that is non invasive and can provide immediate diagnosis disfungsi heart as well as information related to etiology, which may be required specific treatment. Ekokardiografi even mentioned that should be used first as a tool in the diagnosis and management of heart failure in addition to monitoring treatment (Majid, 2001).

d. Catheterises Heart
In most patients with heart failure, clinical examination and testing non invasive already can determine the size and function ventricle left, good enough to confirm the diagnosis. Catheterises heart must be left if necessary remove valve disease and must determine if the coronary arterial disease as well as knowledgeable affected. Right heart Catheterises useful for select and monitor therapy if the patient refractors to standard therapy (Tierney et al. 2002).