TABLE 28-4 Diagnostic Criteria for Heart Failure in Population-Based Studies

Framingham Criteria MAJOR CRITERIA Paroxysmal nocturnal dyspnea or orthopnea Neck-vein distention Rales Cardiomegaly Acute pulmonary edema S3 gallop Increased venous pressure, >16 cm H2O Hepatojugular reflux MINOR CRITERIA Ankle edema Night cough Dyspnea on exertion Hepatomegaly Pleural effusion Vital capacity decreased by one third from maximal capacity Tachycardia (rate > 120 beats /min) NHANES Criteria CATEGORY History CRITERIA Dyspnea Does patient have shortness of breath when hurrying on flat ground or a slight elevation? Does patient have shortness of breath when walking on flat ground? Does patient stop for breath when walking at an ordinary pace? Does patient stop for breath after 100 yards when on flat ground? Heart rate 91-110 beats/min >110 beats/min Jugular venous pressure > 6 cm H2O alone Plus hepatomegaly or edema Ralesbasilar crackles Cracklesmore than basilar crackles Upper zone flow redistribution Interstitial pulmonary edema Interstitial edema plus pleural fluid Alveolar fluid plus pleural fluid POINTS 1 1 2 2 1 2 1 2 1 2 1 2 3 3 MAJOR OR MINOR CRITERIA Weight loss > 4.5 kg in 5 days in response to treatment

Physical examination

Chest radiography

TABLE 30-1

Clinical Features of Heart Failure with Normal Ejection Fraction

Framingham criteria for diagnosis of heart failure (two major or one major and two minor criteria) Major Paroxysmal nocturnal dyspnea or orthopnea Jugular venous distention (or central venous pressure > 16 mm Hg) Rales or acute pulmonary edema Cardiomegaly Hepatojugular reflex Circulation time > 25 seconds Response to diuretic (weight loss > 4.5 kg in 5 days) Minor Ankle edema Nocturnal cough Exertional dyspnea Pleural effusion Vital capacity < two thirds of normal Hepatomegaly Tachycardia (>120 beats/min)