Chronic heart failure

Symptoms

  • Dyspnea.
  • Orthopnea.
  • Fatigue.
  • Nocturnal dyspnea.
  • Anorexia.
  • Weight gain.

Signs

  • Peripherals oedema.
  • Tachycardia.
  • S3.
  • Elevated jugular pressure.
  • Pleural effusion.
  • Rales or crackles.

Etiology and work up

  • ECG
  • Chest X-ray.
  • Echocardiography._
  • Blood test (CBC, Na, K, BNP, urea, creatinin, AST, ALT, γGT, troponin, blood sugar) In heart failure BNP is usually > 400 pg/ml. If < 100 pg/ml, consider other diagnosis.
  • Non invasive test to detect ischemia, coronarography.
  • Arrhythmia detection (ECG, Holter, ET)
  • Drugs or alcool consumption.
  • Medication (chemiotherapy, antidepressive drugs, phenothiazin, anti TNF).
  • Infectious tests (VIH, Lyme disease, Coxsackie, Chagas, jellyfish, snakes, scorpions).

Treatment