Conclusions
This review has served to highlight the key presenting characteristics of patients with AHF based upon the most recent observational data. Much information can be gleaned from the background history with a significant cardiac history and common risk factors (e.g. hypertension) frequently present. Of the presenting symptoms, dyspnoea is sensitive but not specific, while the more classic symptoms (orthopnoea, paroxysmal nocturnal dyspnea) are higher value but frequently absent. Typical examination findings (jugular venous distension, third heart sound) and radiographic features (PVBD, interstitial oedema, alveolar oedema) are also highly specific but insensitive.
More crucially, the above data illustrate that patients with AHF are a heterogenous group, compounded by imprecise diagnostic criteria and co-morbidity (COPD, musculoskeletal disease, cognitive impairment), which may mask important clinical features. The key to improving the time to diagnosis in AHF rests upon a high index of clinical suspicion alongside a readiness to initiate relevant additional tests (biomarkers, echocardiography) and facilitate the early involvement of specialist care.