See the Additional information box for more information on BNP.
To do today
- Urinalysis & Blood test – U&Es, FBC, TFTs, LFTs, glucose: Basic early investigations are necessary to differentiate heart failure from other conditions and to provide prognostic information. Urinalysis, serum urea and creatinine tests may help to determine if there is kidney failure, since symptoms of kidney disease are similar to those of CHF.
- ECG /-: If an ECG is normal, the diagnosis is unlikely to be heart failure. Remember the definition: a diagnosis of heart failure requires an underlying abnormality of the heart combined with symptoms of breathlessness, fatigue and oedema.
- CXR: Chest x-ray may indicate signs of CHF such as cardiomegaly, pulmonary congestion or pleural effusion and also non-cardiac indications such as lung tumours which account for breathlessness.
- Echo: echocardiography is recommended in patients with suspected heart failure who have either a raised brain natriuretic peptide or N terminal-pro-BNp level or abnormal electrocardiograph result to confirm the diagnosis and establish the underlying cause. This is the gold standard for diagnosis of heart failure
- BNP (see additional information box)This is a blood test that shows if these are peptide hormones being produced. BNP and NT-proBNP concentrations are raised in patients with heart failure and can be useful in diagnosis or in referral for echo. These tests are not widely available in Scotland.
To do when results come back
- Prescribing medication: It is important patients diagnosed with heart failure commence evidence based therapies as soon as possible to reduce symptoms and improve outcomes. Thereafter it is imperative these medications are titrated to maximum tolerated dose.
- Education: early supported education has been demonstrated to improve outcomes, support self management, reduce emotional problems and reduce hospital admission. An important part of this is early referral and assessment by specialist heart failure nurse.
Page last reviewed: 28 Jul 2020
