Heart failure is a clinical syndrome characterised by the symptoms and signs that occur due to a reduced cardiac output and/or increased filling pressures.

Types

Causes

Clinical features of heart failure

	Reduced perfusion	Pulmonary congestion (LVF)	Systemic congestion (RVF)
Symptoms	•Fatigue •Exercise intolerance	•SOB on exertion, orthopnoea •Paroxysmal nocturnal dyspnoea  •White/pink frothy sputum       •Cardiac wheeze	•Peripheral oedema •Weight gain •Bloating and reduced appetite
Signs	•Cyanosis •Tachypnoea/ tachycardia •Cool extremities •Oliguria	•Pulmonary oedema (fine basal creps) •Pleural effusions •S3/ventricular gallop •Hypotension (in advanced heart failure)	•Raised JVP •Peripheral oedema (pedal, sacral, scrotal) •Hepatomegaly •Ascites

Investigations

To confirm diagnosis 

• Serum B-type natriuretic peptide
• Chest X-ray
• Echocardiography: diagnostic test and may help determine cause

To determine cause

• Bloods: FBC, U&Es, TFTs, LFTs, ferritin, transferrin saturation, lipid profile, HbA1C, vasculitic/rheumatological screen, viral serologies (e.g. HIV)
• ECG: look for ischaemia, arrhythmias, small complexes (amyloid/pericardial effusion)
• Angiogram or functional imaging: if suspect ischaemic heart disease
• Cardiac MRI: if poor echo windows, suspected infiltrative cause, or unclear cause

Management

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