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

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 ³.
• 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 ³,¹.
• Electrocardiogram (ECG) to assess for arrhythmias or ischemic changes ¹,³.
• Chest X-ray to evaluate for pulmonary congestion, alternative diagnoses, or complications ¹,³.
• 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 ¹.

These investigations are essential to confirm diagnosis, assess severity, identify precipitating factors, and guide urgent management in acute heart failure ³,¹.