Lesson topic №27 ХСН (Сhronic heart failure )
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Symptoms
Typical symptoms include breathlessness, fatigue, and ankle swelling.
Symptoms
Symptoms
Diagnostic tests: basic investigations
Basic investigations such as serum urea and electrolytes, creatinine, full blood count, liver and thyroid function tests are recommended to differentiate HF from other conditions, to provide prognostic information, and to guide potential therapy.
Diagnostic tests: ESG
Electrocardiogram (ECG). A normal ECG makes the diagnosis of HF unlikely. The ECG may reveal abnormalities such as AF, Q waves, LV hypertrophy (LVH), and a widened QRS complex that increase the likelihood of a diagnosis of HF and also may guide therapy.
Diagnostic tests: X-ray
A chest X-ray is recommended to investigate other potential causes of breathlessness (e.g. pulmonary disease). It may also provide supportive evidence of HF (e.g. pulmonary congestion or cardiomegaly).
Diagnostic tests: natriuretic peptides
Measurement of natriuretic peptides are recommended, if available. A plasma concentration of B-type natriuretic peptide (BNP) <35 pg/mL, N-terminal pro-B- type natriuretic peptide (NT-proBNP) <125 pg/mL make a diagnosis of HF unlikely.
Plasma concentrations of NPs are recommended as initial diagnostic tests in patients with symptoms suggestive of HF to rule out the diagnosis.
Elevated concentrations support a diagnosis of HF, are useful for prognostication, and may guide further cardiac investigation.
It should be noted that there are many causes of an elevated NP—both CV and non-CV—that might reduce their diagnostic accuracy.
These causes include AF, increasing age, and acute or chronic kidney disease.
NP concentrations may be disproportionately low in obese patients.
Diagnostic tests: echocardiography
Echocardiography is recommended as the key investigation for the assessment of cardiac function. As well as the determination of the LVEF, echocardiography also provides information on other parameters such as chamber size, eccentric or concentric LVH, regional wall motion abnormalities (that may suggest underlying CAD, Takotsubo syndrome, or myocarditis), RV function, pulmonary hypertension, valvular function, and markers of diastolic function.
Recommended tests to determine the underlying aetiology of CHF
Exercise or pharmacological stress echocardiography may be used for the assessment of inducible ischaemia in those who are considered suitable for coronary revascularization.
Coronary angiography is recommended in patients with HF, who have angina pectoris or an ‘angina equivalent’ despite pharmacological therapy, in order to establish the diagnosis of CAD and its severity.
Computed tomography coronary angiography (CTCA) may be considered in patients with a low to intermediate pre-test probability of CAD, or those with equivocal non-invasive stress tests in order to exclude the diagnosis of CAD.
Cardiac magnetic resonance (CMR) allows myocardial characterization in, e.g. myocarditis, amyloidosis, sarcoidosis, Chagas disease, Fabry disease, LV noncompaction CMP, haemochromatosis, and arrhythmogenic cardiomyopathy (AC).
Scintigraphy has shown high sensitivity and specificity for imaging cardiac transthyretin amyloid.
