Boston Criteria for Diagnosing Heart Failure

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Criterion

Point value

Category I: history

 

Rest dyspnea

4

Orthopnea

4

Paroxysmal nocturnal dyspnea

3

Dyspnea while walking on level area

2

Dyspnea while climbing

1

Category II: physical examination

 

Heart rate abnormality (1 point if 91 to 110 beats per minute; 2 points if more than 110 beats per minute)

1 or 2

Jugular venous elevation (2 points if greater than 6 cm H2O; 3 points if greater than 6 cm H2O plus hepatomegaly or edema)

2 or 3

Lung crackles (1 point if basilar; 2 points if more than basilar)

1 or 2

Wheezing

3

Third heart sound

3

Category III: chest radiography

 

Alveolar pulmonary edema

4

Interstitial pulmonary edema

3

Bilateral pleural effusion

3

Cardiothoracic ratio greater than 0.50

3

Upper zone flow redistribution

2

No more than 4 points are allowed from each of three categories; hence the composite score (the sum of the subtotal from each category) has a possible maximum of 12 points. The diagnosis of heart failure is classified as “definite” at a score of 8 to 12 points, “possible” at a score of 5 to 7 points, and “unlikely” at a score of 4 points or less.

 

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