If your patient has breathlessness, fatigue or swollen ankles, it could be heart failure1
Order an NT-proBNP test — a simple blood test could change it all
Heart failure signs and symptoms1,2
Symptoms
Typical symptoms
- Breathlessness in general or when lying down (orthopnea)
- Shortness of breath that awakens the patient (paroxysmal nocturnal dyspnea)
- Reduced exercise tolerance
- Fatigue, tiredness, increased time to recover after exercise
- Swollen ankles
Less typical symptoms
- Nocturnal cough
- Wheezing
- Bloated feeling
- Loss of appetite
- Confusion (especially in the elderly)
- Depression
- Heart palpitations
- Dizziness
- Fainting
- Shortness of breath when leaning forward
Signs
More specific signs
- Elevated jugular venous pressure
- Hepatojugular reflux
- Third heart sound
- Laterally displaced apical impulse
Less typical signs include
- Weight gain (>2 kg/week)
- Weight loss (in advanced heart failure)
- Tissue wasting
- Cardiac murmur
- Peripheral swelling (e.g. sacral, scrotal)
- Pulmonary crackles
- Rapid beating of the heart (tachycardia)
- Irregular pulse
- Abnormally rapid breathing
- Cold extremities
- Narrow pulse pressure
If it could be heart failure, order an NT-proBNP test to investigate — a simple blood test could change it all.
Explore how to test and referRisk factors
A diagnosis of heart failure is more likely in patients with:1,2,4
Hypertension
Diabetes
A history of cigarette smoking
Coronary artery disease
Previous myocardial infarction
Obesity
Additional risk factors include:1,4
Common co-morbidities for heart failure include:5,6
Who should be tested?
Susan
Age : 65
Gender : Female
Height : 148 cm
Weight : 53 kg
Pre-existing conditions:
Atrial fibrillation
High cholesterol
Hypertension
Dr Patel
Could Susan have heart failure and should her NT-proBNP levels be tested?
Explanation:1,2
Susan had described breathlessness, therefore it could be heart failure and an NT-proBNP test should be ordered to rule out heart failure.
Additionally, Susan has:
- Described another heart failure symptom — paroxysmal nocturnal dyspnoea
- Risk factor associated with heart failure — hypertension
- A co-morbidity – atrial fibrillation
For further information, see the Think heart failure page
Richard
Age : 84
Gender : Male
Height : 175 cm
Weight : 95 kg
Pre-existing conditions:
COPD
Hypertension
Asthma
Hip replacement in 2006
Dr Jones
Could Richard have heart failure and should his NT-proBNP levels be tested?
Explanation:1,2,5,6
Richard has described swollen ankles, therefore it could be heart failure and an NT-proBNP test should be ordered to rule out heart failure.
Additionally, Richard has:
- Described another heart failure symptom — cold extremities
- Risk factor associated with heart failure — hypertension
- A common heart failure co-morbidity — COPD
For further information, see the Think heart failure page
Betty
Age : 77
Gender : Female
Height : 156 cm
Weight : 70 kg
Pre-existing conditions:
Hypertension
Diabetes
Arthritis
Osteoporosis
Glaucoma
Dr Khan
Could Betty have heart failure and should her NT-proBNP
levels be tested?
Explanation:1,2
Betty had described fatigue, therefore it could be heart failure and an NT-proBNP test should be ordered to rule out heart failure.
Additionally, Betty has:
- Described another heart failure symptom — reduced exercise tolerance
- Risk factors associated with heart failure — hypertension and diabetes
For further information, see the Think heart failure page
The patient profiles displayed in this material are hypothetical.
COPD, chronic obstructive pulmonary disease; NT-proBNP, N-terminal pro-B-type natriuretic peptide.
References
1. McDonagh TA, et al. Eur Heart J. 2021;42:3599–3726. 2. Heindenreich PA, et al. JACC. 2022;79:e263–e421. 3. Wong CW, et al. J Card Fail. 2021;27:925–933. 4. Groenewegen A, et al. Eur J Heart Failure. 2020;22:1342–1356. 5. Rabe KF, et al. Eur Respir Rev. 2018;27:180057. 6. Drozd M et al. Heart. 2021;107:1417–1421.