Document Detail

Recent developments in the management of heart failure.
MedLine Citation:
PMID:  22916582     Owner:  NLM     Status:  MEDLINE    
The typical presentation of heart failure in primary care is insidious, with progressive breathlessness on exertion, ankle swelling, orthopnoea or paroxysmal nocturnal dyspnoea. Not all patients will have all these symptoms, and in many patients there may be other causes. If a GP suspects heart failure, then the key blood test is B-type natriuretic peptide (BNP). If the BNP is normal then heart failure is unlikely and other diagnoses should be considered. If it is raised, or if there is a past history of myocardial infarction, the patient requires further assessment, which must include echocardiography and a specialist assessment. The underlying cardiac abnormality should be identified. An ECG is often very useful and if it is completely normal it makes heart failure less likely. Both the NICE and the ESC guidance emphasise the importance of lifestyle management (regular appropriate exercise, avoiding excessive salt and alcohol consumption). ACE inhibitors (or angiotensin receptor blockers) and beta-blockers licensed for heart failure (carvedilol, bisoprolol, nebivolol) remain the mainstay of treatment in addition to as small a dose of diuretic as possible to control any fluid retention. Aldosterone antagonism is recommended by the 2012 ESC guidance for all patients who remain symptomatic despite an ACE inhibitor and beta-blocker. If the rhythm is sinus but the heart rate is 75 beats per minute, therapy needs to be optimised, perhaps by increasing the beta-blocker dose, if possible, or by the addition of ivabradine.
Martin R Cowie
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Practitioner     Volume:  256     ISSN:  0032-6518     ISO Abbreviation:  Practitioner     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-08-24     Completed Date:  2012-09-11     Revised Date:  2013-11-25    
Medline Journal Info:
Nlm Unique ID:  0404245     Medline TA:  Practitioner     Country:  England    
Other Details:
Languages:  eng     Pagination:  25-9, 3     Citation Subset:  IM    
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MeSH Terms
Benzazepines / therapeutic use
Cyclic Nucleotide-Gated Cation Channels / therapeutic use
Heart Failure / complications,  diagnosis*,  drug therapy
Mineralocorticoid Receptor Antagonists / therapeutic use
Natriuretic Peptide, Brain / blood
Patient Care Team
Peptide Fragments / blood
Spironolactone / analogs & derivatives,  therapeutic use
Ventricular Dysfunction, Left / etiology
Reg. No./Substance:
0/Benzazepines; 0/Cyclic Nucleotide-Gated Cation Channels; 0/Mineralocorticoid Receptor Antagonists; 0/Peptide Fragments; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 155974-00-8/ivabradine; 27O7W4T232/Spironolactone; 6995V82D0B/eplerenone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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