Cardiology  |  Heart Failure Pathway - Additional Investigations


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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