Last reviewed: 27 Dec 2022
Last updated: 11 Mar 2022
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)
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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
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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
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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
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Investigations to consider
- venous or arterial blood gas
- blood tests screening for myocarditis
- bedside thoracic ultrasound
Full details
Treatment algorithmPage Error | BMJ Best Practice
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