Heart Failure Pathway - Additional Investigations
Consider the following investigations:
- Basic blood tests - FBC, LFT, TSH, electrolytes, creatinine.
- BNP or NTproBNP (peptide secreted from ventricle especially when under strain)Chest XR:
- NTproBNP > 236 pmol/l or BNP > 116 pmol/l suggests heart failure.
- NTproBNP < 47 pmol/l or BNP < 29 pmol/l - heart failure unlikely or heart failure treated
- BNP/NTproBNP intermediate values can occur with - renal failure, atrial fibrillation, left ventricular failure, COPD, cor-pulmonale, advanced age
- Chest xray.
- Spirometry - useful in the differential diagnosis of dyspnoea and also to determine whether reversible bronchospasm exists which may stop the use of a beta-blocker.
- Sleep studies if sleep apnoea suspected.
- Echo can be a very important tool in the assessment of probable heart failure. However, resources are limited and a direct GP access service to echo is not currently available.
Access to echo should be available on request for the following patients:
- Progressive or severe (NYHA III-IV) despite initial medical therapy.
- Suspected valvular basis to heart failure.
- Suspected peripartum cardiomyopathy.
- Young patient (eg <65y).
Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016
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