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Boston Criteria for Diagnosing Heart Failure

Criterion

Point value

Category I: history

 

Rest dyspnea

4

Orthopnea

4

Paroxysmal nocturnal dyspnea

3

Dyspnea while walking on level area

2

Dyspnea while climbing

1

Category II: physical examination

 

Heart rate abnormality (1 point if 91 to 110 beats per minute; 2 points if more than 110 beats per minute)

1 or 2

Jugular venous elevation (2 points if greater than 6 cm H2O; 3 points if greater than 6 cm H2O plus hepatomegaly or edema)

2 or 3

Lung crackles (1 point if basilar; 2 points if more than basilar)

1 or 2

Wheezing

3

Third heart sound

3

Category III: chest radiography

 

Alveolar pulmonary edema

4

Interstitial pulmonary edema

3

Bilateral pleural effusion

3

Cardiothoracic ratio greater than 0.50

3

Upper zone flow redistribution

2

No more than 4 points are allowed from each of three categories; hence the composite score (the sum of the subtotal from each category) has a possible maximum of 12 points. The diagnosis of heart failure is classified as "definite" at a score of 8 to 12 points, "possible" at a score of 5 to 7 points, and "unlikely" at a score of 4 points or less.

 

Related Criteria

NYHA Functional Classification for Congestive Heart Failure

Framingham Criteria for Congestive Heart Failure

Cardiovascular Major Risk Factors

Duke Criteria for Infective Endocarditis (IE)

Revised Jones Criteria for Acute Rheumatic Fever (ARF)

Wells Clinical Prediction Rule for Pulmonary Embolism and Deep Venous Thrombosis

Braunwald Classification of Unstable Angina (UA)

More...

 

References:

  1. Marantz PR, Tobin JN, Wassertheil-Smoller S, Steingart RM, Wexler JP, Budner N, Lense L, Wachspress J. The relationship between left ventricular systolic function and congestive heart failure diagnosed by clinical criteria. Circulation. 1988 Mar;77(3):607-12. [Medline]

  2. Remes J, Miettinen H, Reunanen A, Pyorala K. Validity of clinical diagnosis of heart failure in primary health care. Eur Heart J. 1991 Mar;12(3):315-21. [Medline]

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Created: July 17, 2006
Last Modified: 10/17/2010

 
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