Patient

1
Cardiology Suspected NEW Heart Failure
Patient Pathway June 2005
Patient Presentation
GP

• New onset breathlessness
• Ankle oedema
• Dyspnoea on exertion / rest
• Orthopnoea
• Fatigue / tiredness

History including previous cardiac history and
examination to exclude red flag signs and
symptoms. Tests required 12 Lead ECG, full blood
count, UE, TFTs, LFTs, glucose, chest x-ray,
urinalysis
if ECG is not available
Perform BNP (B-Type Natriuretic Peptide) test
Normal ECG but still suspect heart failure
Abnormal ECG
Abnormal BNP
Normal BNP

• RED FLAG SYMPTOMS
• Previous cardiac history
• Paroxysmal nocturnal dyspnoea
• Tachycardia/new onset AF
• Increased jugular venous pressure
• Gallop rhythm
• New heart murmur with symptoms
• Lung crepitations
• Sleep apnoea

GP
Refer for non-cardiac assessment
Obtain echocardiogram (and ECG if not already
done) and refer
Confirmed left ventricular systolic dysfunction
(LVSD)
No LVSD
Secondary Care
Cardiology Consultant
Consider hospital admission dependent on severity
of symptoms
GP
Refer for Specialist opinion

• Consider starting appropriate therapies ACEI
  diuretic therapy (if not already initiated).
• Once stable introduce beta-blocker.
• Asses future cardiovascular risk cholesterol,
  smoking, diabetes, hypertension and diet.

Useful information for patients with confirmed
LVSD
Heart Failure Service
Refer for further specialist assessment and
consideration for long term follow-up by Nurse
Specialist (see useful information for patients
with confirmed LVSD)

• Record daily weight
• Change to low sodium diet
• Early symptom recognition and reporting
• Importance of medication compliance
• Flu Pneumococcal immunisations

Secondary Care
www.cci.scot.nhs.uk
Patient
Primary Care