Diagnosis of Heart Failure

Question 1

How would NICE suggest suspected Heart failure be diagnosed?

Answer 1

1. Careful, detailed history and examination
2. Blood tests e.g BNP, Troponin T
3. Perform an ECHO if BNP or ECG is positive

Question 2

What tests can be done when suspecting Heart failure?

Answer 2

Bloods: BNP, Troponin, FBC, U&E, TFT, LFT, LIpids, Glucose
ECG
Urinalysis
CXR
ECHO
Peak Flow

Question 3

ECG signs of Heart Failure:

Answer 3

• AF
• Signs of previous MI e.g STEMI
• LVH (S V1, R V5/6)
• Bundle branch block (marrow/william)
• Axis deviation
• Studies have shown the diagnosis of heart failure is unlikely if the ECG is normal (Mant et al, 2009)

Question 4

ECHO signs of heart failure:

Answer 4

• Systolic dysfunction
• Diastolic dysfunction
• LV wall thickness (atrophied or hypertrophied)
• Valve disease
• Raised pulmonary artery pressure (indicator of congestion)

Question 5

Strengths and Pitfalls to current guidelines surrounding heart failure diagnosis:

Answer 5

• Clinical features are based on ‘accepted practice and pathophysiology’ but there is no evidence to support their use in heart failure diagnosis (Conolly and Gillespie)
• BNP and ECG backed by evidence but no evidence to support the cut off points used
• No evidence surrounding the use of ECHO
• Lack of evidence for chronic HF, mostly acute