The management of worsening heart failure

Abstract

Heart failure is a heterogeneous progressive syndrome of symptoms and signs, a culmination of structural and/or functional abnormalities of the heart. There is an elevated intracardiac pressure or reduced cardiac output at rest or during exercise. An echocardiogram evaluation is almost essential to diagnose heart failure with reduced ejection fraction (HFrEF) i.e. left ventricular ejection fraction (LVEF) ≤ 40%, or heart failure with preserved ejection fraction (HFpEF) i.e. LVEF ≥ 50%; and also to evaluate the structure of the heart itself, the pericardium and the structure and function of the valves. Biomarkers such as elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) are increasingly used to evaluate global function as stretching of the myocardium due to the elevated intracardiac pressure is responsible for their elevation. The 2017 American guidelines of heart failure recommend that in patients presenting with dyspnoea, measurement of NT-proBNP is useful to support a diagnosis of heart failure.