Heart Education Awareness Resource and Training through eLearning (HEARTe)
Red flag for heart failure
Q. Which of the following symptoms are red flags for heart failure.
Heart Failure
Not Heart Failure
Breathlessness – sign that left ventricle is not working effectively
Lethargy – oxygenated blood not being pumped effectively from heart meeting bodily muscle demands
Oedema – fluid accumulation within the cells causing swelling of peripheries and abdomen (ascites)
Cough – fluid accumulation in the lungs can cause a cough, usually characterised with frothy white phlegm expectorated
Orthopnoea (unable to lie flat) – lungs can be congested when lying down
PND (waking up breathless) – waking up breathless as the redistribution of the fluid accumulated in body tissues moves to lungs, patients can describe feelings of suffocation or drowning
Tachycardia – Increased heart rate is one of the bodies compensatory mechanisms to try and increase cardiac output (sympathetic nervous system, fight or flight)
raised JVP – raised jugular venous pressure is see in HF patients who have severe symptoms of fluid congestion and is an emergency 999 red flag in most cases
Weight gain – extra fluid retention in the body causes weight gain in heart failure. 1 litre of fluid weighs about 2Ibs/1kg
Fever – No, but it may be a cause that requires further examination and can make heart failure symptoms worse
Blurred vision – No, but may require investigation as it could be due to hypotension and medications initiation
dehydration – No, but in heart failure management fluid management and dehydration should be considered as requiring further assessment especially with over use of diuretic therapy
Wheeze – No, but in severe heart failure the patient often has co-morbidities so a respiratory assessment may be required
Heartburn/indigestion – No, patients can complain of gastric symptoms for many reasons
Joint pain – no, but this could be down to a lot of different factors including gout which should be investigated if it continues
Headaches – not specific to HF
Weight loss – not specific to HF but people can develop cachexia (weight loss) with end stage heart failure
depression – not specific to HF
Pulse point
Remember the definition of heart failure from the introduction:
Definition of heart failure (NICE Clinical Guideline No 106, September 2018): A complex clinical syndrome of symptoms and signs that suggest impairment of the heart as a pump supporting physiological circulation.’‘It is caused by structural or functional abnormalities of the heart.’
You may want to revisit the definition of HF. SIGN 147 states;
“There is no symptom or sign that is both sensitive and specific for the diagnosis of CHF and a purely clinical diagnosis is problematic “.
Remember:
In clinical practice it is the combination of symptoms and signs, and the presence or otherwise of a likely cause of heart failure which is most useful.
