Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • exertional dyspnoea

Other diagnostic factors

  • orthopnoea
  • paroxysmal nocturnal dyspnoea
  • abdominal fullness
  • rales
  • jugular venous distension
  • hepatojugular reflux
  • congestive hepatomegaly
  • lower extremity oedema
  • laterally displaced apical impulse
  • gallop sounds

Risk factors

  • hypertension
  • female sex
  • age >70 years
  • obesity
  • coronary artery disease/ischaemia
  • diabetes mellitus
  • chronic kidney disease
  • myocardial and pericardial disorders
  • obstructive sleep apnoea

Diagnostic investigations

1st investigations to order

  • serum electrolytes
  • renal function tests
  • liver enzymes
  • B-natriuretic peptide (BNP)/N-terminal prohormone B-natriuretic peptide (NT-pro-BNP)
  • FBC
  • 12-lead ECG
  • CXR
  • Doppler echocardiography
  • tissue Doppler imaging (TDI)
Full details

Investigations to consider

  • cardiac magnetic resonance (CMR) imaging
  • CT angiography
  • radionuclide ventriculography (MUGA scan)
  • stress testing
  • cardiac catheterisation and coronary angiography
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Cardiologist

Guys and St Thomas’ NHS Foundation Trust

London

UK

Disclosures

GCW declares that he has no competing interests.

Cardiology Specialist Registrar

Guys and St Thomas’ NHS Foundation Trust

London

UK

Disclosures

JW declares that she has no competing interests.

Dr Gerald Carr-White and Dr Jessica Webb would like to gratefully acknowledge Dr Gerard Aurigemma, Dr Lokesh Tejwani, Dr Marc E. Del Rosario, and Dr Kul Aggarwal, previous contributors to this monograph. GA, LT, MEDR, and KA declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor of Medicine

Cardiovascular Division

Washington University School of Medicine

St. Louis

MO

Disclosures

EG has lectured for Novartis, Forest, Merck, and Pfizer.

Consultant Cardiologist

Darlington Memorial Hospital

Darlington

UK

Disclosures

Not disclosed.

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