In vestiga tions

Test

Diagnosis

ECG

Myocardial ischaemia/infarction, arrhythmias

CXR

With left heart failure: pulmonary oedema (interstitial perihilar ('bat's wing') shadowing, upper lobe blood diversion, Kerley B lines, pleural effusion) ± cardiomegaly

Pulmonary artery catheter

Low cardiac output and stroke volume, low mixed venous oxygen saturation (<60%), raised PAWP (with left heart failure), raised RAP (with right heart failure). V waves with mitral or tricuspid regurgitation

Blood tests

Low SaO2, variable PaCO2, base deficit >2mmol/l, hyperlactataemia, low venous O2 (mixed or central venous), raised cardiac enzymes, troponin, BNP, thyroid function (if indicated)

Echocardiogram

Poor myocardial contractility, pericardial effusion, valve stenosis/incompetence

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