What are the key clinical features to assess in a patient presenting with acute decompensated heart failure?

When assessing a patient presenting with acute decompensated heart failure (ADHF), the key clinical features to evaluate include symptoms and signs of fluid overload and impaired cardiac function. Symptoms typically involve worsening breathlessness, orthopnoea, paroxysmal nocturnal dyspnoea, fatigue, and reduced exercise tolerance. Signs to assess include raised jugular venous pressure, peripheral oedema (notably in the ankles, sacrum, abdomen, and genitalia), fine lung crepitations indicating pulmonary congestion, hepatomegaly due to liver engorgement, and a postural drop in blood pressure greater than 20 mmHg suggesting hypovolaemia. Additionally, the pulse should be checked for regularity and rate to identify arrhythmias such as atrial fibrillation or atrial tachycardia, which may precipitate or worsen heart failure. Functional capacity should be assessed using the New York Heart Association (NYHA) classification to gauge the impact on daily activities. Cognitive status and psychosocial factors, including anxiety and depression, should also be evaluated as they influence management and prognosis. Vital signs including heart rate, blood pressure, respiratory rate, and oxygen saturation are essential to monitor. Investigations such as ECG, chest X-ray, and measurement of serum natriuretic peptides (BNP or NT-proBNP) are recommended to support diagnosis and assess severity. Echocardiography should be performed promptly to evaluate cardiac structure and function. Monitoring renal function, electrolytes, and urine output is critical during treatment. Weight changes should be tracked to assess fluid status. Overall, a comprehensive clinical assessment integrating these features guides diagnosis, severity assessment, and management planning in acute decompensated heart failure NICE CKS,NICE CG187 Zannad et al. 2006.