Dr. Eric Letovsky and Dr. Brian Steinhart describe a practical way to approach patients with undifferentiated SOB and acute heart failure (AHF), the utility of various symptoms and signs in the diagnosis of AHF, as well as the controversies surrounding the best use of BNP and Troponin in the ED.  A discussion of the use of ultrasound for patients with SOB as well as the indications for formal Echo are reviewed. In the second part of the episode they discuss the management of AHF based on a practical EM model, as well as the difficulties surrounding disposition of patients with AHF.

Despite recent advances in the management of acute heart failure, the one year mortality remains unchanged in the last 30 years. Emergency physcians are only about 80% accurate in their diagnoses of patients with acute heart failure. Dr. Steinhart and Dr. Letovsky have a combined clinical experience of 60 years. They discuss the best clinical predictors for the diagnosis of acute heart failure, how we can use BNP to improve our diagnostic accuracy, and key clinical pearls in management. They answer questions like: How can we differentiate patients with COPD exacerbations from patients with acute heart failure? Which physical examination findings have the best likelihood ratios for acute heart failure? How can the ECG help us discover the cause of acute heart failure? What are the indications for an urgent Echo in the ED? Should we be using BNP in Canadian emergency departments? Why does NIPPV work so well for patients with acute pulmonary edema? What is the evidence for furosemide, nitroglycerine, ACE Inhibitors, milrinone and dobutamine in the treatment of acute heart failure? When should we suspect peripartum cardiomyopathy? Which patients are safe to send home? And many many more…..