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Heart failure - chronic - Management
How do I assess and investigate someone with suspected chronic heart failure?
- If heart failure is suspected on the basis of the person's symptoms and signs and medical history (such as previous myocardial infarction [MI]):
- If the person has not had a previous MI, measure their natriuretic peptide level (availability may vary according to locality) — either B-type natriuretic peptide (BNP) or N-terminal pro-BNP.
- If the person has had an MI in the past, do not measure their natriuretic peptide level, as referral for specialist assessment and echocardiography is indicated regardless of natriuretic peptide levels.
- In all people, do 12-lead electrocardiography. In addition, consider other tests to evaluate for possible aggravating factors and to exclude other conditions with similar presentations:
- Chest X-ray.
- Blood tests: urea and electrolytes, creatinine, full blood count, thyroid function, liver function, glucose, lipids.
- Urinalysis.
- Lung function tests (peak flow or spirometry).
- Assess for and manage any underlying causes (where appropriate).
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