Treatment can be initiated before any diagnostic testing has been completed if a clear case of heart failure has been identified. However, in cases where the diagnosis is unclear, further diagnostic studies can be helpful. All patients, even those believed to have a clear diagnosis, require a basic workup to evaluate for any secondary causes or underlying organ dysfunction.
An ECG should be performed promptly on every patient with suspected decompensated heart failure in order to evaluate for a strain pattern or evidence of acute coronary ischemia and to screen for a dysrhythmia that could explain the deterioration. ADHF may be the presenting picture in STEMI. (See Figure 2. ) Vasodilators should not be used among patients presenting with an inferior STEMI (ie, ST elevations in II, III, and aVF), as these patients are often preload dependent, and administration of vasodilators could result in a dangerously low blood pressure.
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