Heart Failure

Local guidelines now available and have been read.
Key points -
Consider doing Brain Natriuretic Peptide test when it is available, normal levels are negatively predictive for heart failure.
Everyone should have an ECG (normal is >90% predictive of not having Heart Failure) and if diagnosed with HF an echo.
Control arrhythmias.
Everyone should have a max tolerable dose of ACEI or A2RA (monitor creatine).
Diuretics do not improve exercise tolerance but can clear peripheral and pulmonary oedema, use at lowest dose to get improvement and monitor U+E's.

Establish aetiology and treat underlying causes - IHD and hypertension are commonest causes. Consider valvular heart disease, alcohol excess and familial causes.

Use the New York Heart Association classification of symptoms and consider referral to Class III and IV

General stuff - those on frusemide >80mg daily should be on a twice weekly weight chart and fluctuations of 2kg in 3 days should prompt review of diuretic Rx. Some patients can be taught to adjust this themselves. Aim for a healthy, low salt diet. Long haul flights are contraindicated in those who are so breathless that they need to stop after climbing a flight of stairs or who cannot hold a conversation without symptoms. Travel - hot climates might need adjustment of diuretic. Encourage aerobic exercise. Avoid soluble forms of tablets because of sodium content. Avoid NSAIDs.