Symptoms we assess
Breathlessness on exertion or when lying flat, waking at night short of breath, swollen ankles, fatigue, reduced exercise tolerance and rapid weight gain from fluid. Heart failure is often first suspected by a GP from these symptoms and a blood test (NT-proBNP), and confirmed with an echocardiogram.
Diagnosis
- Echocardiogram to measure the ejection fraction and distinguish a weak heart (reduced ejection fraction) from a stiff heart (preserved ejection fraction)
- ECG and, where needed, Holter monitoring for rhythm problems that can cause or worsen heart failure
- Blood tests for kidney function, iron, thyroid and diabetes
- CT coronary angiogram or other imaging to look for coronary disease as the underlying cause
Treatment
For heart failure with reduced ejection fraction there are now four groups of medicines that each improve survival, and the aim of the clinic is to get you onto all of them at the right doses, safely and quickly. This involves a series of visits over a few months with blood tests between them. Some patients benefit from a device such as a pacemaker or defibrillator, and A/Prof Verjans coordinates referral for these through the Royal Adelaide Hospital.
Alongside medicines, we cover fluid and salt intake, daily weighing, activity, vaccination, and what to do if symptoms change. Your GP and, where relevant, the hospital heart failure service receive a copy of every plan.
Follow-up
Stable patients are usually seen every three to six months, with telehealth follow-up available where appropriate. Results, letters and your current medication list are available to you in the Patient Hub.