Suspected Acute Heart Failure Clinical Pathway — Emergency Department, ICU and Inpatient

Further Diagnostic Work-up
Cardiac Catheterization
  • Evaluate pulmonary artery pressure (especially with restrictive CM)
  • Rule out a coronary anomaly
  • Consider an endomyocardial biopsy (EMB)
  • Class 1 indications for EMB
  • New onset HF (< 2 weeks) with a normal-sized or dilated LV and hemodynamic compromise
  • New onset HF (2 weeks – 3 months duration) associated with a dilated LV and new ventricular arrhythmias, second- or third-degree heart block, or failure to respond to usual care within 1 to 2 weeks
MRI
  • Consider to further delineate the etiology of heart failure (e.g. myocarditis) and better characterize the myocardium for inflammation and fibrosis.
Evaluate Source
Use Cardiomyopathy or Myocarditis order set
  • Respiratory Virus Panel
  • Myoplasma
  • Parvovirus
  • Adenovirus
  • RSV
  • Influenza A/B
  • Parainfluenza A/B
  • Metapneumovirus
  • Rhinovirus
  • Serum
  • Enteroviruses (coxsackievirus)
    • CMV, EBV, HHV-6
    • Parvovirus B19
    • Adenovirus
    • Parechovirus
    • HIV
    • Mycoplasma
  • Cultures
  • Blood, urine and sputum
  • Urine
  • Adenovirus, enterovirus, parechovirus