Heart failure learning module 2: diagnosis

Released1 November 2017     Expires: 01 November 2019      Programme:

Introduction

The signs and symptoms of heart failure are common and notoriously non-specific (table 1). Some 10–20% of patients who are admitted via the emergency department who are eventually diagnosed as having acute heart failure may have initial treatment for an alternative diagnosis, for example chronic obstructive airway disease.1,2

Misdiagnosis and underdiagnosis are also common in the community; as many as 16% of patients over the age of 65 presenting with breathlessness to their general practitioner (GP) may have undiagnosed heart failure as the cause.3 The prevalence of systolic dysfunction (left ventricular ejection fraction [LVEF] <50%) in patients over 45 years of age may be as high as 6%; much higher than the current estimated heart failure prevalence of 1-2% in the UK.4

Heart failure learning module - Table 1. Common and uncommon signs and symptoms of heart failure
Table 1. Common and uncommon signs and symptoms of heart failure

The heart failure syndrome is a broad spectrum ranging from those presenting in extremis to the emergency department to patients presenting to their GPs with symptoms for many months.

Acute heart failure generally refers to patients presenting as emergencies to hospital, usually with either pulmonary oedema or with gross fluid retention. Such patients are often presenting for the first time, but may be patients having an exacerbation of their previously stable heart failure; sometimes described as ‘decompensated’ heart failure. They have acutely abnormal haemodynamics.

In contrast, most patients with chronic heart failure have been treated medically and will usually have few, if any, symptoms or signs at rest. The term ‘congestive’ heart failure, often used to describe patients in this condition (particularly in North America), is inappropriate: patients with treated heart failure should not be congested.3,4

The diagnosis of heart failure requires the combination of symptoms suggestive of the condition, appropriate abnormalities on imaging and raised serum natriuretic peptides (see below).

THERE ARE CURRENTLY NO COMMENTS FOR THIS ARTICLE - LEAVE A COMMENT

All rights reserved. No part of this programme may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publishers, Medinews (Cardiology) Limited.

It shall not, by way of trade or otherwise, be lent, re-sold, hired or otherwise circulated without the publisher’s prior consent.

Medical knowledge is constantly changing. As new information becomes available, changes in treatment, procedures, equipment and the use of drugs becomes necessary. The editors/authors/contributors and the publishers have taken care to ensure that the information given in this text is accurate and up to date. Readers are strongly advised to confirm that the information, especially with regard to drug usage, complies with the latest legislation and standards of practice.

Healthcare professionals should consult up-to-date Prescribing Information and the full Summary of Product Characteristics available from the manufacturers before prescribing any product. Medinews (Cardiology) Limited cannot accept responsibility for any errors in prescribing which may occur.