Summary
Definition
History and exam
Key diagnostic factors
- breathlessness
- peripheral oedema
- reduced exercise tolerance
- fatigue
- cold extremities
- elevated jugular venous pressure
- risk factors
- displaced apex beat
- gallop rhythm (third heart sound)
Other diagnostic factors
- nocturnal cough
- wheezing
- dizziness
- confusion
- loss of appetite
- nocturnal ischaemic pain
- ascites
- central cyanosis
- narrow pulse pressure
- altered mental status
- oliguria
- delayed capillary refill time
- pulmonary crepitations
- dullness to percussion/decreased air entry in lung bases
Risk factors
- previous cardiovascular disease
- older age
- prior episode of heart failure
- diabetes mellitus
- family history of ischaemic heart disease or cardiomyopathy
- excessive alcohol intake
- smoking
- cardiac arrhythmias
- history of systemic conditions associated with heart failure
- previous chemotherapy
- medication
- hypertension
- valvular heart disease
- pericardial disease
- myocarditis
- excessive salt intake
- excessive catecholamine stimulation
- abnormal thyroid function
Diagnostic investigations
1st investigations to order
- ECG
- chest x-ray
- natriuretic peptides
- troponin
- full blood count
- urea, electrolytes, and creatinine
- glucose and HbA1c
- liver function tests
- thyroid function tests
- C-reactive protein
- D-dimer
- echocardiography
Investigations to consider
- venous or arterial blood gas
- blood tests screening for myocarditis
- bedside thoracic ultrasound
Treatment algorithm
Contributors
Expert advisers
Resham Baruah, MBBS, BSc, MRCP, PhD
Consultant Cardiologist
Chelsea and Westminster Hospital and the Royal Brompton and Harefield NHS Trust
London
UK
Disclosures
RB has received honorarium/speaker fees from Novartis and Boehringer Ingleheim.
Adam D. Hartley, MBBS, BSc, MRCP
Wellcome Trust Clinical Research Fellow
Imperial College London
Specialist Registrar in Cardiology
Imperial College Healthcare NHS Trust
London
UK
Disclosures
ADH declares that he has no competing interests.
Acknowledgements
Best Practice would like to gratefully acknowledge the previous expert contributor, whose work is retained in parts of the content:
Syed Wamique Yusuf, MBBS, FACC, FRCPI
Professor of Medicine
Department of Cardiology
University of Texas
MD Anderson Cancer Center
Houston
TX
Peer reviewers
Lisa Anderson, BSc, MB, ChB, MD
Consultant Cardiologist
Cardiovascular Clinical Academic Group
Molecular and Clinical Sciences Research Institute
St George's, University of London
St George's University Hospitals NHS Foundation Trust
London
UK
Disclosures
LA was deputy chair for the British Society of Heart Failure clinical advisory board for tafamidis, undertook consultancy services for tafamidis (Pfizer), received a research grant from Pfizer, was on the clinical advisory board for dapagliflozin (AstraZeneca), and received lecture fees from the British Society of Cardiology/AstraZeneca and Pfizer.
James Gamble, BM, BCh, DM, FRCP
Consultant Cardiologist
Oxford Heart Centre
John Radcliffe Hospital
Oxford
UK
Disclosures
JG has been reimbursed for delivering educational meetings by: Novartis, the manufacturer of sacubitril/valsartan; Boerhinger Ingelhiem, the manufacturer of empagliflocin; AstraZeneca, the manufacturer of dapagliflozin; and Medtronic, the manufacturer of implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices. He has been supported to attend educational meetings by Abbott, Medtronic, and Boston Scientific, who all manufacture ICD and CRT devices. All of these companies produce drugs or devices related to the treatment of heart failure.
Editors
Susan Mayor,
Lead Section Editor, BMJ Best Practice
Disclosures
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
Annabel Sidwell,
Section Editor, BMJ Best Practice
Disclosures
AS declares that she has no competing interests.
Rachel Wheeler,
Lead Section Editor, BMJ Best Practice
Disclosures
RW declares that she has no competing interests.
Julie Costello,
Comorbidities Editor, BMJ Best Practice
Disclosures
JC declares that she has no competing interests.
Adam Mitchell,
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
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