12. HF part 1: Evaluation of new onset heart failure with Dr. Ed Kasper

The evaluation of new-onset heart failure has evolved from rigid, standardized protocols to a patient-centered approach driven by detailed history, family background, and physical examination. Dr. Ed Kasper, Director of Clinical Cardiology at Johns Hopkins Medicine, emphasizes that initial clinical assessment—including family history and physical findings—should dictate subsequent diagnostic testing. While invasive hemodynamic evaluation via right heart catheterization remains a cornerstone for assessing filling pressures, advanced imaging like cardiac MRI and PET scans now play a critical role in identifying specific etiologies such as sarcoidosis or amyloidosis. Genetic counseling is increasingly vital, as familial factors contribute to a significant portion of idiopathic dilated cardiomyopathies. Selective endomyocardial biopsy is reserved for cases where specific diagnoses like giant cell myocarditis are suspected, ensuring that diagnostic interventions are targeted, evidence-based, and clinically meaningful.