- PN: What has made you stop cycling to work?
- Raza: My heart’s beating so hard, I’m out of breath, I get so tired.
- PN: How long has this been going on for?
- Raza: Probably around 6 weeks.
- PN: Do you feel breathless at any other time?
- Raza: Yes, if I’m hurrying or climbing up the stairs.
- PN: Do you have any cough or spit just now?
- Raza: Yes, I have a cough and sometimes frothy spit
- PN: Are you wakening up during the night breathless and how many pillows are you using?
- Raza: No, but I’m having to use an extra pillow
- PN: What about your tiredness?
- Raza: I’m tired all the time, with no energy and can hardly do anything.
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.
Page last reviewed: 28 Jul 2020
