A process in which patients presenting with shortness of breath, fatigue, and edema are assessed for heart failure with ECG, echocardiography, and blood tests, and a guideline-based treatment plan is established.
Indication
- Shortness of breath worsening with exertion, occurring at night, or while lying down
- Bilateral leg swelling (edema) and rapid weight gain
- Unexplained fatigue and a clear decrease in exercise capacity
- History of prior heart attack, valvular heart disease, or uncontrolled hypertension
- Need for cardiac monitoring after diabetes, chronic kidney disease, or chemotherapy
- Patients presenting with arrhythmia or syncope and suspected structural heart disease
Preparation
- Bring all current heart medications and the most recent prescriptions
- Bring previous ECG, echocardiogram, and blood test results
- Come fasting in the morning if a blood test is planned
- Share salt and fluid intake habits with the physician
- Limit smoking, alcohol, and energy drinks the day before
How it's performed
- Detailed history-taking, including assessment of NYHA class, edema, and exercise tolerance
- Physical examination assessing jugular venous distension, lung auscultation findings, and peripheral edema
- Investigation of structural heart disease using ECG, chest X-ray, and transthoracic echocardiography
- Monitoring of BNP/NT-proBNP, complete blood count, kidney and thyroid function, and electrolytes
- Planning of coronary angiography, cardiac MRI, or genetic testing for etiology when indicated
- Stepwise initiation of medical therapy in line with ESC/ACC guidelines (ACEi/ARB/ARNI, beta-blocker, MRA, SGLT2i)
Post-procedure
- Kidney function and potassium check within 2-4 weeks of starting treatment
- Outpatient follow-up every 3-6 months in stable patients
- Echocardiographic assessment of left ventricular function at least once a year
- Continued daily weight monitoring, salt restriction, and an exercise routine
- Electrophysiology consultation regarding indications for a pacemaker or ICD
Risks
- Acute decompensation requiring hospitalization
- Arrhythmias (atrial fibrillation, ventricular tachycardia) and related thromboembolic complications
- Side effects of medications (hypotension, changes in kidney function, hyperkalemia)
- Decline in exercise capacity and reduced quality of life with uncontrolled disease
- Risk of pulmonary hypertension and cardiac syncope at advanced stages
FAQ
Can heart failure go away?
In some causes (tachyarrhythmia-related, alcohol- or drug-induced, peripartum), substantial improvement may occur with treatment, while in most patients heart failure is a long-term condition managed with follow-up and medication.
Why is daily weight monitoring important?
A sudden weight gain of 2 kg or more within a few days may signal fluid retention; in this case, the physician should be consulted to adjust medication doses.
How should I follow salt restriction?
Daily salt intake is generally recommended to be kept below 5 grams; attention should be paid to hidden sources of salt such as processed foods, pickles, brined items, and fast food.
Can I exercise?
In stable patients, supervised aerobic and resistance exercises support the endurance of the heart muscle; the intensity and duration of the program should be planned together with your physician.
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