Heart failure

Data gathering

  • Red flags – chest pain
  • Others – SOB, orthopnoea, PND, leg swelling, exercise tolerance
  • Examine – BP, pulse, sats, RR, weight, chest, CVS (JVP, legs)

Clinical management

  • Investigations
    • Bloods – FBC, U+E, LFTs +- BNP (see below)
    • CXR
    • ECG
    • Echo (see below)
  • Explanation
  • Treatment
    • Lifestyle – BP, diet, exercise, smoking
    • Medications – Furosemide, ACE-I, B-blocker
    • Heart failure clinic – titrate/monitor meds, consider spiro/digoxin/bivent pacemaker
  • Followup / Safety-net
    • Refer to cardiology
      • Unclear aetiology – stress echo/MRI/angiogram may be requried
      • NYHA 3 or above
      • Co-existent renal failure
      • Correctable cardiac abnormality e.g. valvular disease, IHD
      • Progressive symptoms
      • Consider end-of-life care for advanced heart failure – see here

BNPs and Echocardiograms

  • Measure BNP if heart failure suspected and no previous MI
    • <100 ng/L – heart failure unlikely
    • 100-400 ng/L – echo within 6 weeks
    • > 400 ng/L – echo within 2 weeks
  • Organise echo within 2 weeks if heart failure suspected and previous MI

NYHA classification of severity

  • NYHA class I – ordinary physical activity does not cause breathlessness/fatigue/palpitations
  • NYHA class II – comfortable at rest but ordinary physical activity does cause symptoms
  • NYHA class III – comfortable at rest but less than ordinary physical activity causes symptoms
  • NYHA class IV – symptoms at rest

References