"When your heart is under strain from a CHF exacerbation, this can result in increased levels of certain specialized proteins in the blood. Two of these proteins are called BNP and troponin. The hospital team order these tests and others to help figure out the best next steps in your treatment. A commonly used measurement to determine whether it's okay to go home is the oxygen saturation. Sometimes we will also measure this number while you are walking to see if it drops with physical activity. In addition to having an adequate amount of oxygen in the blood, ER doctors frequently look at other factors to determine the severity of the CHF and whether a patient should be treated at home or in the hospital. Other factors that are considered include whether you're feeling better, whether you have access to your medications and whether you're able to follow up with your primary care team or cardiologist. Importantly, you have to have a way to get back to the hospital if you get worse, if you haven't been able to get your fluid reduced with the home doses of furosemide or torsemide, or have other new issues like kidney injury or worsening heart function, you may need to stay in the hospital. The same goes, if you need a machine to support your breathing. This includes bi-pap or intubation. Some patients do really well with a bigger dose of the water pill and a few hours on bi-pap in the ER. If this is something that has worked for you in the past, it's possible this experience has helped your ER doc to decide that you can indeed go home. When you are discharged from the hospital or at your first outpatient follow-up appointment, ask to go over the treatment plan for your CHF, including when you should go to the hospital. The most concerning symptoms of congestive heart failure include inability to breathe, new difficulty catching your breath when walking or climbing stairs and difficulty breathing when you lay flat. Other serious symptoms that should bring you back to the ER, include fainting, chest pain, as well as cough with frothy or bloody sputum. If you have a heart rate greater than 100 beats per minute, you should call your cardiologist or come back to the ER. If you already have CHF with a low ejection fraction, it's often a good idea to be checked at an office visit whenever you have any new symptoms. Many physical stresses, including illnesses and infections, can trigger a CHF exacerbation. So keeping ahead of other health issues is very important. Fluid buildup in your legs is also concerning, but can often be treated with a medication adjustment by your primary care team or your cardiologist. You may not need to come back into the emergency department in this situation. In general, most patients with CHF are able to continue their treatment at home. You should call your primary care provider or cardiologist as soon as you get home to set up an appointment or with any questions. There may be some prescriptions that work better than what you're on. Be sure to call your doc."
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