Download CHF: Diagnosis of Heart Failure

CHF: Diagnosis of Heart Failure
Reference # 210
CHF: Diagnosis of Heart Failure
Key Highlights from the Recommended Guideline
Diagnose heart failure when the patient has both
(a) clinical evidence of impaired cardiac output and/or volume
overload, and
(b) abnormal systolic or diastolic function by diagnostic imaging
Scope: Health professionals involved in the care of adult patients with suspected heart failure
How do I diagnose heart failure accurately in a patient in whom I
suspect heart failure?
Establish the diagnosis of heart failure and identify modifiable risk factors by clinical
examination and laboratory testing. [Level of Evidence: Class I, Level C]
• The triad of edema, fatigue, dyspnea is not sensitive or specific
• Patients may have heart failure
o
Without having volume overload
o
With a normal ejection fraction
Some Common
Precipitants
Coronary artery disease,
thyroid dysfunction, drugs
Also consider if appropriate,
rarer causes
Signs and Symptoms
dyspnea, orthopnea,
paroxysmal nocturnal dyspnea,
cough, weight gain, abdominal
distension, nocturia, dependent
edema, fluid overload, cool
extremities
Uncommon Signs and
Symptoms
altered mentation or
cognitive impairment,
nausea, abdominal
discomfort, oliguria,
cyanosis
Perform transthoracic echocardiography to assess ventricular size and function, or if
unavailable, gated radionuclide ventriculography. [Level of Evidence: Class I,
Level C]
Document the patient’s functional capacity using the New York Heart Association
(NYHA) or another validated measure. [Level of Evidence: Class I, Level C]
NYHA Classification
I = No symptoms
II = Symptoms with ordinary activity
III = Symptoms with less than ordinary activity
IV = Symptoms with minimal activity or at rest
o
A 6 minute walk test may be helpful
Screen first-degree relatives if the patient has a family history of cardiomyopathy or
sudden death. [Level of Evidence: Class I, Level C]
www.gacguidelines.ca
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CHF: Diagnosis of Heart Failure
Reference # 210
What if you suspect that coronary artery disease is contributing to the heart
failure?
Consider coronary angiography. [Level of Evidence: Class I, Level C]
o Radionuclide imaging, cardiopulmonary exercise testing may also be helpful
What if you are uncertain of the clinical diagnosis?
Consider testing levels of plasma B-type or brain natriuretic peptides (BNPs).
[Level of Evidence: Class IIa, Level A]
Consider measuring BNP in patients with an established diagnosis of heart failure for
prognostic stratification. [Level of Evidence: Class IIa, Level A]
Consider measuring BNP sequentially to guide the therapy of patients with heart failure.
[Level of Evidence: Class IIb, Level B]
Levels of Evidence
Class I
Class II
Class IIa
Class IIb
Class III
Level A
Level B
Level C
Evidence or general agreement that a given procedure or treatment is beneficial, useful and
effective.
Conflicting evidence or a divergence of opinion about the usefulness or efficacy of the
procedure or treatment.
Weight of evidence is in favour of usefulness or efficacy.
Usefulness or efficacy is less well established by evidence or opinion.
Evidence or general agreement that the procedure or treatment is not useful or effective and
in some cases may be harmful.
Data derived from multiple randomized clinical trials or meta-analyses.
Data derived from a single randomized clinical trial or nonrandomized studies.
Consensus of opinion of experts and/or small studies.
The above recommendations were derived from the following GAC endorsed
guidelines:
Arnold, J.M.O., Liu, P., Demers, C. et al. and the Canadian Cardiovascular Society. (2006, January).
Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis
and management. Canadian Journal of Cardiology, 22(1), 23-45.
Arnold, J.M.O., Howlett, J.G., Dorian, P., Ducharme, A., Giannetti, N., Haddad, H. et al. (2007, January).
Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007:
Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers.
Canadian Journal of Cardiology, 23(1), 21-45.
Rating (out of 4):
Endorsed Date: May, 2007
Planned Review Date: July, 2009
Ontario Guidelines Advisory Committee
500 University Ave., Suite 650
Toronto, ON M5G 1V7
Telephone: 1-888-512-8173
Fax: 416-971-2462
Email: [email protected]
www.gacguidelines.ca
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