Here are the most telling signs of acute congestive heart failure on chest x-ray and clinical examination.

Chest x-ray

  • Pulmonary venous congestion (LR+ 12, LR– 0.48)
  • Interstitial edema (LR+ 12, LR– 6.8)
  • Alveolar edema (LR+ 6.0, LR– 0.95)
  • Cardiomegaly (LR+ 3.3, LR– 0.33)
  • Pleural effusions (LR+ 3.2, LR– 0.81)
  • Any edema (LR+ 3.1, LR– 0.38)

Clinical examination

  • S3 heart sound (LR+ 11, LR– 0.88)
  • Abdominal jugular reflex (LR+ 6.4, LR– 0.79)
  • Jugular venous distension (LR+ 5.1, LR– 0.66)
  • Rales (LR+ 2.8, LR– 0.51)
  • Any murmur (LR+ 2.6, LR– 0.81)

References

The rational clinical examination. JAMA (2005)