For patients admitted with acute decompensated heart failure, do you wait until the patient is euvolemic before ordering a TTE?

For patients with newly diagnosed CHF, I always get a TTE prior to discharge to establish a baseline study. It would help me identify valvular disease and pulmonary hypertension, or other structural problems. If a TTE would help you distinguish CHF from other volume overload conditions, then I would order it to help make a diagnosis.

If a patient has a known diagnosis of CHF and there are no other concerns, I will order a TTE when near or approaching euvolemia, typically on the day of discharge or as an expedited outpatient TTE. A non-congested TTE would help reassess their EF (for ICD) and avoid volume-dependent stretching or regurgitation.

I recommend POCUS early during admission and repeat TTE near euvolemia for patients with known CHF ...