A clinicoradiographic scoring system for the diagnosis of congestive heart failure was developed at Massachusetts General Hospital in Boston. This can help decide if long term medication for heart failure can be discontinued in patients who no longer show symptoms of heart failure.
Finding categories:
(1) history
(2) physical examination
(3) chest radiography
|
Category I: History |
Findings |
Points |
|
rest dyspnea |
absent |
0 |
|
|
present |
4 |
|
orthopnea |
absent |
0 |
|
|
present |
4 |
|
paroxysmal nocturnal dyspnea |
absent |
0 |
|
|
present |
3 |
|
dyspnea on walking on level area |
absent |
0 |
|
|
present |
2 |
|
dyspnea on climbing |
absent |
0 |
|
|
present |
1 |
points for history =
= MIN(4,SUM(points for findings present))
|
Category II: Physical Exam |
Finding |
Points |
|
heart rate abnormality |
<= 90 beats/min |
0 |
|
|
91-110 beats/min |
1 |
|
|
> 110 beats/min |
2 |
|
jugular venous pressure elevation |
<= 6 cm H2O |
0 |
|
|
> 6 cm H2O |
2 |
|
|
> 6 cm H2O plus (hepatomegaly or edema) |
3 |
|
lung crackles |
none |
0 |
|
|
basilar |
1 |
|
|
more than basilar |
2 |
|
wheezing |
present |
3 |
|
|
absent |
0 |
|
third heart sound |
present |
3 |
|
|
absent |
0 |
points for physical examination =
= MIN(4,SUM(points for findings present))
|
Category : Chest Radiography |
Finding |
Points |
|
alveolar pulmonary edema |
present |
4 |
|
|
absent |
0 |
|
interstitial pulmonary edema |
present |
3 |
|
|
absent |
0 |
|
bilateral pleural effusions |
present |
3 |
|
|
absent |
0 |
|
cardiothoracic ratio |
> 0.50 |
3 |
|
|
<= 0.50 |
0 |
|
upper zone flow redistribution |
present |
2 |
|
|
absent |
0 |
points for chest radiography =
= MIN(4,SUM(points for findings present))
score =
= (points for history) + (points for physical examination) + (points for chest radiography)
Interpretation:
• minimum score: 0
• maximum score: 12
• A score > 4 points corresponds to a pulmonary capillary wedge pressure >= 12 mm Hg (sensitivity 90%, specificity 85%).
|
Score |
Diagnosis |
|
<= 4 |
CHF unlikely |
|
5 - 7 |
CHF possible |
|
>= 8 |
CHF definite |
Purpose: To use a clinicoradiographic scoring system for the diagnosis of congestive heart failure.
Specialty: Cardiology
Objective: response to therapy, drug levels
ICD-10: I50,
