Unlike myocardial infarction or pulmonary edema, the diagnosis of acute heart failure syndrome can be elusive. History and physical exam are not always accurate when attempting to establish the diagnosis. However,the best physical exam finding suggestive of an elevated pulmonary capillary wedge pressure is the S3 heart sound, with a specificity of 99%.
Dyspnea (A) has a sensitivity and specificity 50%. Jugular venous distension (B) has a specificity of 94% and a sensitivity of 39%. Orthopnea (C) has a specificity of 88%.
Peacock WF: Congestive Heart Failure and Acute Pulmonary Edema, in Tintinalli JE, Kelen GD, Stapczynski JS (eds): Emergency Medicine, A Comprehensive Study Guide, ed 7. New York, McGraw-Hill, 2011, (Ch) 57:p 405-414.