{"id":829,"date":"2017-05-22T06:37:07","date_gmt":"2017-05-22T06:37:09","guid":{"rendered":"http:\/\/papergp.com\/?page_id=829"},"modified":"2023-01-24T11:25:25","modified_gmt":"2023-01-24T11:25:25","slug":"heart-failure","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/cardiovascular\/heart-failure\/","title":{"rendered":"Heart failure"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4><strong>Data gathering<\/strong><\/h4>\n<ul>\n<li>Red flags &#8211; chest pain<\/li>\n<li>Others &#8211; SOB, orthopnoea, PND, leg swelling, exercise tolerance<\/li>\n<li>Examine &#8211; BP, pulse, sats, RR, weight, chest, CVS (JVP, legs)<\/li>\n<\/ul>\n<\/div>\n<div class=\"content-box-blue\">\n<h4><strong>Clinical management<\/strong><\/h4>\n<ul>\n<li>Investigations\n<ul>\n<li>Bloods &#8211; FBC, U+E, LFTs +- <a href=\"https:\/\/gps.camdenccg.nhs.uk\/pathways\/heart-failure-diagnostic\">BNP<\/a> (see below)<\/li>\n<li>CXR<\/li>\n<li>ECG<\/li>\n<li>Echo (see below)<\/li>\n<\/ul>\n<\/li>\n<li>Explanation<\/li>\n<li>Treatment\n<ul>\n<li>Lifestyle &#8211; BP, diet, exercise, smoking<\/li>\n<li>Medications &#8211; Furosemide, ACE-I, B-blocker<\/li>\n<li>Heart failure clinic &#8211; titrate\/monitor meds, consider spiro\/digoxin\/bivent pacemaker<\/li>\n<\/ul>\n<\/li>\n<li>Followup \/ Safety-net\n<ul>\n<li>Refer to cardiology\n<ul>\n<li>Unclear aetiology &#8211; stress echo\/MRI\/angiogram may be requried<\/li>\n<li>NYHA 3 or above<\/li>\n<li>Co-existent renal failure<\/li>\n<li>Correctable cardiac abnormality e.g. valvular disease, IHD<\/li>\n<li>Progressive symptoms<\/li>\n<li>Consider end-of-life care for advanced heart failure &#8211; see <a href=\"https:\/\/gps.camdenccg.nhs.uk\/pathways\/end-of-life-care-planning-in-heart-failure-1\">here<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<div class=\"content-box-blue\">\n<h4><strong>BNPs and Echocardiograms<\/strong><\/h4>\n<ul>\n<li>Measure BNP if heart failure suspected and no previous MI\n<ul>\n<li>&lt;100 ng\/L &#8211; heart failure unlikely<\/li>\n<li>100-400 ng\/L &#8211; echo within 6 weeks<\/li>\n<li>&gt; 400 ng\/L &#8211; echo within 2 weeks<\/li>\n<\/ul>\n<\/li>\n<li>Organise echo within 2 weeks if heart failure suspected and previous MI<\/li>\n<\/ul>\n<h4><strong>NYHA classification of severity<\/strong><\/h4>\n<ul>\n<li>NYHA class I &#8211; ordinary physical activity does not cause breathlessness\/fatigue\/palpitations<\/li>\n<li>NYHA class II &#8211; comfortable at rest but ordinary physical activity does cause symptoms<\/li>\n<li>NYHA class III &#8211; comfortable at rest but less than ordinary physical activity causes symptoms<\/li>\n<li>NYHA class IV &#8211; symptoms at rest<\/li>\n<\/ul>\n<\/div>\n<h4><strong>References<\/strong><\/h4>\n<ul>\n<li><a href=\"https:\/\/gps.camdenccg.nhs.uk\/pathways\/heart-failure-diagnostic\">https:\/\/gps.camdenccg.nhs.uk\/pathways\/heart-failure-diagnostic<\/a><\/li>\n<li><a href=\"http:\/\/gp.barnetccg.nhs.uk\/downloads\/services\/pathways\/Cardio\/Heart-failure-protocol-12-October-2017-v1.pdf\">http:\/\/gp.barnetccg.nhs.uk\/downloads\/services\/pathways\/Cardio\/Heart-failure-protocol-12-October-2017-v1.pdf<\/a><\/li>\n<li>https:\/\/www.enhertsccg.nhs.uk\/sites\/default\/files\/pathways\/Heart%20Failure%20-%20Suspected%20%28inc%20LVSD%29_0.pdf<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Data gathering Red flags &#8211; chest pain Others &#8211; SOB, orthopnoea, PND, leg swelling, exercise tolerance Examine &#8211; BP, pulse, sats, RR, weight, chest, CVS (JVP, legs) Clinical management Investigations Bloods &#8211; FBC, U+E, LFTs +- BNP (see below) CXR ECG Echo (see below) Explanation Treatment Lifestyle &#8211; BP, diet, exercise, smoking Medications &#8211; Furosemide, &hellip; <a href=\"https:\/\/papergp.com\/index.php\/cardiovascular\/heart-failure\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Heart failure<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":284,"menu_order":51,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-829","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/829","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=829"}],"version-history":[{"count":10,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/829\/revisions"}],"predecessor-version":[{"id":2391,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/829\/revisions\/2391"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/284"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=829"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}