Labs
Troponin
Lactate
CBC
WBC elevated with a left shift
Chem
LFTs
elevated due to liver hypoperfusion
ABG
anion gap acidosis
BNP
ECG
CXR
TTE
Troponin
Lactate
CBC
WBC elevated with a left shift
Chem
LFTs
elevated due to liver hypoperfusion
ABG
anion gap acidosis
BNP
WBC elevated with a left shift
elevated due to liver hypoperfusion
anion gap acidosis
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
Cardiogenic shock
Cardiogenic
Undifferentiated shock 
Acute valvular Regurgitation/VSD
Undifferentiated shock
CHF
Neurogenic shock
Dysrhythmia