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Heart failure - chronic - Management
When should I suspect chronic heart failure?
It can be difficult to diagnose chronic heart failure because the symptoms and signs are often difficult to elicit and are often found in other common conditions.
- Suspect chronic heart failure if the person has typical symptoms and signs of heart failure, and risk factors in their medical or social history.
- Symptoms
- Breathlessness — on exertion (or at rest if the person has severe heart failure), on lying flat (orthopnea), or waking from sleep (paroxysmal nocturnal dyspnoea).
- Fatigue (tiredness, exhaustion, decreased exercise tolerance — due to a combination of breathlessness and fatigue).
- Fluid retention (ankle swelling, abdominal swelling).
- Signs
- Laterally displaced apex beat.
- Raised jugular venous pressure.
- Enlarged liver (due to engorgement).
- Third or fourth heart sound (gallop rhythm).
- Tachycardia.
- Lung crackles (persisting after coughing).
- Dependent oedema (legs, sacrum).
- Medical and social history
- Myocardial infarction, coronary artery disease, or angina.
- Atrial fibrillation.
- Diabetes mellitus.
- Hypertension.
- Excessive alcohol consumption.
- Cardiotoxic chemotherapy in the past.
- Family history of heart failure or sudden cardiac death from cardiomyopathy at a young age.
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