RISK FACTORS, SIGNS & SYMPTOMS, INVESTIGATIONS & DIAGNOSIS
RISK FACTORS
Female >70 years
COPD
Diabetes mellitus
Renal failure
- Liver failure
- Structural/functional cardiac disorders.
| SIGNS & SYMPTOMS
– Shortness of breath |
– Ankle swelling – Increased
AVP – Bibasal crepitations – Peripheral oedema – Laterally displaced apex beat |
| Gallop rhythm
– Hypertension – Hyperventilation – Increased heart rate |
– Increased respiratory rate |
INVESTIGATIONS & DIAGNOSIS
Initial tests:
- BNP (<100 normal, 100-400 6-week referral, >400 2-week referral)
- false positives: female, > 70, COPD, diabetes, renal & liver failure, structural or functional cardiac issues
- false negatives: obesity, diuretics, ACE inhibitors/ARB’s, beta-blockers, aldosterone antagonists, Afro-Caribbean origin
- NT-proBNP (<400 normal, 400-2000 6-week referral, >2000 2-week referral) – ECG – Echo
- Blood tests as indicated (U&e, LFT, TFT, FBC, Iron study, HBA1c, Fasting lipids) – other investigations: lung function test, urine dip (to look for protein & blood) – NOTE:
During the period of investigation, if the patient is symptomatic, prescribe loop diuretic (furosemide)