In chronic heart failure the heart cannot pump or fill well enough for the body's needs, causing breathlessness, fatigue and fluid buildup. A follow-up visit checks symptoms and fluid status, adjusts the medicines that improve survival and teaches the patient to spot early warning signs.
Key symptoms
- Shortness of breath with effort or when lying flat
- Waking at night short of breath
- Leg swelling and weight gain
- Fatigue and less exercise tolerance
- Poor appetite or abdominal fullness
What you find on exam
- Weight compared with dry weight; blood pressure and heart rate
- Raised jugular venous pressure
- Lung crackles and a third heart sound
- Leg or sacral edema
- NYHA class to track symptoms
Tests
- Kidney function and potassium, especially after drug changes
- BNP or NT-proBNP
- Echocardiogram for ejection fraction
- ECG for rhythm and QRS width
- Blood count, iron studies, thyroid tests
Treatment basics
- Reduced ejection fraction: sacubitril-valsartan, a beta blocker, spironolactone and an SGLT2 inhibitor such as dapagliflozin
- Loop diuretic such as furosemide for fluid
- Daily weights, less salt, regular activity
- Vaccines, cardiac rehab and care of other conditions
- Devices (ICD, CRT) in selected patients
Red flags
- Weight gain of more than 1 kg (2 lb) in a day or 2 kg (5 lb) in a week
- Breathless at rest or unable to lie flat
- Chest pain, fainting or a rising potassium
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.