What initial test is recommended to evaluate suspected congestive heart failure?

B-type natriuretic peptide (BNP) level is the primary initial test recommended for evaluating suspected congestive heart failure (CHF). BNP is a hormone produced by the ventricles of the heart in response to excessive stretching of heart muscle cells, which is commonly seen in heart failure. Elevated levels of BNP in the blood indicate heart failure and help differentiate it from other causes of dyspnea. It rapidly aids in diagnosis and can inform subsequent management decisions.

While the echocardiogram is essential for assessing the structure and function of the heart, it is typically used after the initial assessment to confirm the diagnosis and evaluate specific cardiac issues such as left ventricular dysfunction. Chest X-ray can be useful to visualize heart size and pulmonary congestion, and an ECG can provide information on arrhythmias and myocardial ischemia. However, BNP is specifically indicated for a prompt evaluation of CHF symptoms, making it the preferred initial test in this scenario.