Suspected Acute Heart Failure Clinical Pathway – Emergency Department, ICU and Inpatient – Further Diagnostic Work-Up

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 wks) with a normal-sized or dilated LV and hemodynamic compromise
    • New onset HF (2 wks to 3 mos duration) associated with a dilated LV and new ventricular arrhythmias, second- or third-degree heart block, or failure to respond to usual care within 1–2 wks
MRI
  • Consider further delineating heart-failure etiology (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
Additional Consult Genetics