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Harrison's Principles of Internal Medicine - 19th Edition (April 17, 2015)


Home Criteria Cardiology Boston Criteria for Diagnosing Heart Failure


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Boston Criteria for Diagnosing Heart Failure Print E-mail
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Written by G. Firman MD   
Friday, 27 February 2009 10:36

 

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.

 

 

 

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]


Created: July 17, 2006

 

 


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