Clinical syndrome of impaired cardiac output or congestion, classified by EF (HFrEF ≤40, HFmrEF 41–49, HFpEF ≥50).
Causes
- • Ischaemic heart disease
- • Hypertension
- • Valvular disease
- • Cardiomyopathy
- • Arrhythmia
Risk factors
- • Prior MI
- • DM
- • HTN
- • Obesity
- • OSA
- • CKD
Clinical features
- • Dyspnoea (exertional, orthopnoea, PND)
- • Fatigue
- • Ankle swelling
- • Nocturnal cough
Examination
- • Raised JVP
- • Displaced apex, S3
- • Bibasal crackles
- • Peripheral oedema
- • Hepatomegaly
Investigations
- • BNP/NT-proBNP
- • ECG, CXR (cardiomegaly, ABCDE signs)
- • Echo (EF, valves, diastolic function)
- • U&E, TFT, iron studies, HbA1c
Diagnosis
- • NYHA class I–IV
- • BNP >35 / NT-proBNP >125 with echo confirmation
Management
- • HFrEF 4 pillars: ARNI/ACEi, β-blocker, MRA, SGLT2i
- • Loop diuretic for congestion
- • Device therapy: CRT if QRS >130, ICD if EF <35
- • Treat cause
Complications
- • Arrhythmia, SCD
- • Acute decompensation
- • Cardiorenal syndrome
- • Cachexia
Prevention
- • Manage HTN, DM, lipids
- • Avoid NSAIDs
- • Vaccination (influenza, pneumococcal)
Follow-up
- • Daily weights at home
- • U&E 1–2 weeks after titration
- • Echo at 6–12 months
Clinical pearls
- • Start all 4 pillars early — don't wait for tolerance
- • Decongest first in AHF, then optimise GDMT
- • SGLT2i benefit independent of EF and diabetes status
References
- • ESC HF 2023
- • AHA/ACC HF 2022
Related in WardRound
Educational — verify locally.
