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Department of Cardiology, Aubagne Hospital, Aubagne, France
Acute heart failure is one of the most common condition leading to hospital admission and is burdened by important mortality and readmission rates. A timely diagnosis of congestive heart failure at admission by hospitalists is essential for an early and tailored medical management. The initial clinical evaluation based on symptoms, physical signs and chest radiography remains inconclusive for the diagnosis in many patients with acute dyspnea, and the use of natriuretic peptide testing (BNP and NT-proBNP) through a two cut-point strategy is currently recommended as first-line diagnostic complement in the acute care setting. Bedside Doppler echocardiography is another reliable, noninvasive method that offers additional diagnostic information over the initial clinical evaluation. Along with echocardiographic evidence of depressed left ventricular systolic function, several simple Doppler indexes have been validated in the emergency diagnosis of congestive heart failure. Doppler echocardiography at bedside may especially benefit to patients with intermediate, inconclusive natriuretic peptide concentrations. The aim of the present review was to offer to the hospitalist a practical overview on the relative contribution of natriuretic peptide testing and bedside Doppler echocardiography to the diagnosis of acute heart failure in the emergency care setting.