CBC (rule out anemia)
Chem
Albumin level
ECG
CXR
Cephalization
Interstitial<unk> 
Pulmonary venous congestion
Pleural effusion
Alveolar<unk> 
Cardiomegaly
Troponin +/- BNP
Ultrasound
Bedside to assess global function, B lines, assessment of IVC
Formal TTE/TEE
Cephalization
Interstitial<unk> 
Pulmonary venous congestion
Pleural effusion
Alveolar<unk> 
Cardiomegaly
Bedside to assess global function, B lines, assessment of IVC
Formal TTE/TEE
Measurement
<100 pg/mL: Negative for acute CHF (Sn 90%, NPV 89%)
100-500 pg/mL: Indeterminate (Consider differential diagnosis and pre-test probability)
>500 pg/mL: Positive for acute CHF (Sp 87%, PPV 90%)
Combination of BNP with clinician judgment 94% sensitive 70% specific (compared to 49% sn and 96% spec clinical judgement alone) 
<100 pg/mL: Negative for acute CHF (Sn 90%, NPV 89%)
100-500 pg/mL: Indeterminate (Consider differential diagnosis and pre-test probability)
>500 pg/mL: Positive for acute CHF (Sp 87%, PPV 90%)
Combination of BNP with clinician judgment 94% sensitive 70% specific (compared to 49% sn and 96% spec clinical judgement alone) 
<300 pg/mL → CHF unlikely
CHF likely in:
>450 pg/mL in age < 50 years old
>900 pg/mL in 50-75 years old
>1800 pg/mL in > 75 years old
>450 pg/mL in age < 50 years old
>900 pg/mL in 50-75 years old
>1800 pg/mL in > 75 years old
A lines and B lines
A lines:
Appear as horizontal lines
Indicate dry interlobular septa.
Predominance of A lines has 90% sensitivity, 67% specificity for pulmonary artery wedge pressure <= 13mm Hg
A line predominance suggests that intravenous fluids may be safely given without concern for<unk> 
B lines ("comets"):
White lines from the pleura to the bottom of the screen
Highly sensitive for<unk> , but can be present at low wedge pressures
A lines:
Appear as horizontal lines
Indicate dry interlobular septa.
Predominance of A lines has 90% sensitivity, 67% specificity for pulmonary artery wedge pressure <= 13mm Hg
A line predominance suggests that intravenous fluids may be safely given without concern for<unk> 
B lines ("comets"):
White lines from the pleura to the bottom of the screen
Highly sensitive for<unk> , but can be present at low wedge pressures
Appear as horizontal lines
Indicate dry interlobular septa.
Predominance of A lines has 90% sensitivity, 67% specificity for pulmonary artery wedge pressure <= 13mm Hg
A line predominance suggests that intravenous fluids may be safely given without concern for<unk> 
White lines from the pleura to the bottom of the screen
Highly sensitive for<unk> , but can be present at low wedge pressures
Pulmonary edema
Pulmonary
Immersion pulmonary edema
Airway obstruction
Pleural effusion
Anaphylaxis
Pleuritis
Angioedema