Investigations

Question 1

How do you diagnose heart failure as a syndrome?

Answer 1

Patients should have had:
- Symptoms typical of HF (SOB on exertion/rest, fatigue)
AND
- Signs typical of HF (tachycardia, pulmonary/peripheral oedema, raised JVP)
AND
- Objective evidence of structural or functional cardiac abnormality at rest (cardiomegaly, S3)

Question 2

What bloods are used to investigate heart failure?

Answer 2

• FBC
• Haematinics - anaemia, B12
• U+E - also CKD
• TFT - hypo/hyperthyroidism
• Glucose - diabetes

Question 3

What is the main investigation for heart failure?

Answer 3

Brain natriuretic peptide (BNP)

• 32 amino acid polypeptide secreted by the ventricles of the heart in response to excessive stretching of heart muscle cells
• Normal levels rule out HF
• Provides prognostic information

Question 4

What other investigations can be used for heart failure?

Answer 4

• CXR - cardiac size, pulmonary oedema/pleural effusion
• ECG - diagnostic/therapeutic info - AF/arrhythmias, old AMI, LBBB, LVH (HTN, AS, HOCM)

Question 5

What does echocardiography tell you in HF?

Answer 5

Echocardiography is a key investigation.
Provides info relating to ejection fraction of LV (normal approx 60%), patients divided into:
- HF with preserved LV function (EF >45%)
- HF with LV systolic dysfunction (EF < 45%)

Question 6

How does echocardiography help define the aetiology of HF?

Answer 6

• Assessment of valves
• Previous AMI (akinetic/hypokinetic areas)
• Provides info relating to cardiac chamber size/structure i.e. DCM, HOCM