Which investigations should be prioritized in the emergency assessment of acute heart failure?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Prioritized investigations during the emergency assessment of a patient presenting with acute heart failure include:

  • Measurement of serum natriuretic peptides (B-type natriuretic peptide [BNP] or N-terminal pro-B-type natriuretic peptide [NT-proBNP]) to help confirm or rule out heart failure, using thresholds of BNP less than 100 ng/litre or NT-proBNP less than 300 ng/litre to rule out the diagnosis .
  • Transthoracic Doppler 2D echocardiography to establish the presence or absence of cardiac abnormalities, ideally performed within 48 hours of admission to guide early specialist management ,.
  • Electrocardiogram (ECG) to assess for arrhythmias or ischemic changes ,.
  • Chest X-ray to evaluate for pulmonary congestion, alternative diagnoses, or complications ,.
  • Blood tests including renal function profile, thyroid function, liver function, lipid profile, glycosylated haemoglobin (HbA1c), full blood count, and urinalysis to identify precipitating factors or comorbidities .

These investigations are essential to confirm diagnosis, assess severity, identify precipitating factors, and guide urgent management in acute heart failure ,.

Related Knowledge Topics

Educational content only. Always verify information and use clinical judgement.