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cardio.acute-hf.de-novo.v1

Acute heart failure — de novo (first presentation)

cardiologyacuteadultacuteinpatienttransitionoutpatient
Start encounter →Print handoutPRODUCTION

Phase E variant of cardio.acute-hf.core.v1 — narrowed to first-presentation AHF without prior HF diagnosis. Specializes mandatory broad etiology workup (ACS, peripartum CMP, takotsubo, fulminant/giant-cell myocarditis, acute valvular regurgitation, hypertensive crisis, drug/toxin, thyroid disease) and in-hospital GDMT initiation per PIONEER-HF (ARNI 24h post-stabilization) + EMPULSE (SGLT2i in-hospital) + STRONG-HF (high-intensity titration cadence). Manifest pointer reuses cardio.acute-hf.core.v1 manifest. Design-brief pointer reuses parent (de novo specifics documented inline). Status INTEGRATED until terminology + RxNav-validated drug codes are reconciled.

Entry points (3)

  • symptom
    New-onset dyspnea + edema + elevated NT-proBNP without prior HF diagnosis → de novo AHF
    first_presentation_ahf_dyspnea
  • imaging
    First-ever echo showing reduced LVEF + clinical AHF — de novo HFrEF
    new_lvef_reduction_first_echo
  • history
    Pregnant or <5 mo postpartum + new AHF → peripartum CMP workup
    pregnancy_postpartum_ahf

Required inputs (7)

  • agerequired
    demographic • used at CONTEXT
    De novo AHF in young patient broadens etiology (myocarditis, peripartum, congenital, drug/toxin)
  • sbprequired
    vital • used at RED_FLAGS
    BP-stratified phenotype: hypertensive AHF (SBP >140) vs normotensive vs hypotensive (cardiogenic shock)
  • nt_probnprequired
    lab • used at INITIAL_WORKUP
    Diagnostic + prognostic; trend predicts response to therapy
  • troponinrequired
    lab • used at INITIAL_WORKUP
    ACS rule-out is mandatory in de novo AHF; mild elevation common but persistent rise suggests ischemic etiology
  • creatininerequired
    lab • used at CONTEXT
    Cardiorenal interaction; drives diuretic + RAAS dosing
  • tshrequired
    lab • used at INITIAL_WORKUP
    Thyroid disease (hyper/hypo) can precipitate de novo AHF; mandatory in first-presentation workup
  • echo_first_everrequired
    imaging • used at INITIAL_WORKUP
    LVEF + RV + valvular + pericardial; cornerstone of de novo AHF phenotyping

12-phase flow (10)

  1. 1FRAME
    De novo AHF = first presentation without prior HF diagnosis; mandates etiology workup + early GDMT after stabilization
    inputs: nt_probnp
    advance: de novo phenotype confirmed
  2. 2ENTRY
    Stabilize: O2, IV diuresis if congested, vasodilator if hypertensive AHF, vasopressor if shock
    inputs: sbp
    advance: initial stabilization done
  3. 3CONTEXT
    Age, comorbidities, recent pregnancy/postpartum, alcohol/drug use, chemotherapy exposure, family history of CMP
    inputs: age, creatinine
    advance: context complete
  4. 4RED_FLAGS
    ACS rule-out (mandatory in de novo AHF); cardiogenic shock screen; arrhythmia (AF, VT); fulminant myocarditis (cardiac MRI); valvular emergency (acute MR/AR)
    inputs: troponin, sbp
    actions: acs_pathway, cardiogenic_shock
    advance: red-flag screen complete
  5. 5INITIAL_WORKUP
    Echo, NT-proBNP, BMP, CBC, TSH, iron panel, HbA1c, lipid, urine drug screen, SARS-CoV-2 + influenza if seasonal; cardiac MRI if myocarditis or infiltrative suspected
    inputs: nt_probnp, tsh, echo_first_ever
    actions: acute_pulm_edema, panel.cardiac, panel.renal
    advance: etiology workup complete
  6. 6BRANCHING_WORKUP
    Cath if ACS suspected; cardiac MRI if myocarditis/infiltrative; endomyocardial biopsy if fulminant or giant cell suspected; right heart cath if uncertain congestion phenotype
    advance: etiology-specific workup triggered
  7. 7TREATMENT
    IV diuresis (loop + thiazide augmentation if needed); vasodilator if HTN; in-hospital ARNI initiation per PIONEER-HF (24h post-AHF, SBP ≥100, K <5.2, eGFR ≥30); SGLT2i per EMPULSE (in-hospital); BB ONLY after stabilization off IV inotropes
    inputs: sbp, creatinine
    actions: acute_pulm_edema
    advance: in-hospital GDMT bundle started
  8. 8DISPOSITION
    Telemetry floor or CICU based on hemodynamics; advanced HF transfer if shock or fulminant
    advance: unit assigned
  9. 9MONITORING
    Daily weight, I/O, BMP (K, Cr); NT-proBNP trend; daily exam
    inputs: nt_probnp
    actions: panel.cardiac
    advance: monitoring cadence established
  10. 10FOLLOWUP
    STRONG-HF up-titration cadence (weekly visits × 4 wk); cardiac rehab; advanced HF eval if EF <35 + persistent symptoms despite GDMT
    advance: STRONG-HF cadence + cardiac rehab booked