In the clinic physicians have a number of ways to assess when congestion is developing in patients.  Most of these are physical exam-based, some require laboratory testing, and some exploit available in-dwelling technology such as defibrillators and pacemakers.  Of the parameters shown in Figure 12, physical exam parameters and biomarkers such as jugular venous pressure, hepatojugular reflux, an S3 gallop, pulmonary rales, or measurement of brain (B-type) natriuretic peptide (BNP) or N-terminal pro-brain natriuretic peptide (NT-pro-BNP) are challenging to use outside of the clinic setting because they really require a face-to-face encounter with the patient.  Accordingly, they are not of much help in managing patients remotely or in triaging patients who call with worsening symptoms.

Key to abbreviations in Figure:
BNP – brain natriuretic peptide
JVP – jugular venous pressure
LVEDP – left ventricular end-diastolic pressure
PCWP – pulmonary capillary wedge pressure
RAP – right atrial pressure
S3 – third heart sound