Heart Education Awareness Resource and Training through eLearning (HEARTe)
GP consultation
The GP makes Molly more comfortable on the couch before examining her. The GP asks Molly how long this has been getting worse.
Findings
Rationale
Linked to Molly´s heart failure
BP 90/60(sitting)
80/50 (standing)
Low BP is common when symptoms are worsening you should always check erect and supine BPs. check dehydration and medication compliance
Dizziness is worse when standing
Pulse 66 and regular
Check pulse manually as heart failure patients are prone to developing arrhythmia
Molly is on multiple medications which can affect pulse rate and rhythm
NYHA class III – (See Additional Information)
Listen to chest for fluid and/or infection and to assess which NYHA class she is in as compared to previously
NYHA class is deteriorating as she has increased breathlessness and oedema
Routine blood tests
To assess renal function, haemoglobin, liver function, blood glucose in comparison to her previous results
Molly´s symptoms could be linked to worsening blood results
Additional Information
The NYHA classification of heart failure is based on the severity of the patient’s symptoms
Class I
No limitations on activity.
No fatigue, breathlessness or palpitation on ordinary physical activity
–
Annual mortality
3-5%
Class II
Patients are comfortable at rest but ordinary physical activity such as climbing stairs or doing housework results in symptoms
‘Mild’ heart failure
Annual mortality
10%
Class III
Patients have a marked limitation of physical activity. Although patients are comfortable at rest, less than ordinary physical activity will lead to symptoms
‘Moderate’ heart failure
Annual mortality
12-16%
Class IV
Patients have symptoms even at rest and are unable to undertake any physical activity without discomfort
‘Severe’ heart failure
Annual mortality
15-20%
Worse prognosis than most cancers
Adapted from Guidelines for the diagnosis and treatment of Chronic Heart Failure: Task Force Report; Eur. Heart J., 2001
Once a diagnosis of heart failure has been made, the severity of symptoms and level of incapacity can be categorised according to the New York Heart Association (NYHA) classification. This classification recognises four classes in which symptoms increase in severity, increasingly limiting the ability of patients to undertake normal daily activities.
Task Force for the Diagnosis and Treatment of Chronic Heart Failure, European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J 2001;22:1527–60.
Pulse point
Remember in healthy heart module we looked at the importance of assessing pulse manually and accurate blood pressure readings. You may want to review the Healthy Heart module.
