Rational diagnosis of heart failure
Heart failure (HF) is clinically manifested as a set of signs and symptoms caused by complex circulatory and neurohormonal responses to the dysfunction of the heart. Timely and accurate diagnosis of HF enables the effective treatment and significantly improves its prognosis, but is unfortunately made in only about 50% of patients. Diagnosis is based on a detailed history, physical examination, findings of special diagnostic methods and biochemical tests, especially serum levels of natriuretic peptides (BNP, NT-pro BNP). Incorrect diagnosis is most common in patients with preserved left ventricular systolic function. When the diagnosis is made, the degree and form of heart failure and etiology of the disorder should be determined. Common symptoms are shortness of breath on exertion, orthopnea, paroxysmal nocturnal dyspnea, cough, flatulence and nausea. Frequent signs are elevated jugular venous pressure, crepitation and rales in the bases of the lungs, S3 gallop, displaced and forceful apex beat, peripheral edema, hepatomegaly and ascites. Echocardiography is the most useful diagnostic method because it enables confirmation of the diagnosis, assessment of etiology and prognosis of HF. In emergency setting normal BNP or Nt-proBNP serum levels exclude the diagnosis of HF. For rational diagnosis of heart failure it is necessary to have good theoretical and practical clinical knowledge, as well as adherence to guidelines and recommendations for which proper conditions need to be ensured.
Key words:
brain natriuretic peptide; diagnosis; diastolic heart failure; heart failure; symptoms and signs
OGLASI
