Step by step: A guide to diagnosing heart failure
This course provides a structured, step-by-step approach to diagnosing heart failure in clinical practice, aligned with HSE guidance and European Society of Cardiology (ESC) recommendations. It supports clinicians in recognising symptoms, performing differential diagnosis, conducting clinical examination, and appropriately utilising investigations such as NT-proBNP testing and echocardiography. The course also outlines classification of heart failure based on ejection fraction, enabling accurate diagnosis and timely referral for specialist management.
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Learning Outcomes
What you'll learn
- Identify key symptoms and clinical features suggestive of heart failure, including typical and less typical presentations
- Differentiate heart failure from other common causes of breathlessness and peripheral oedema
- Recognise underlying causes, risk factors, and precipitating conditions associated with heart failure
- Perform a focused clinical examination and interpret relevant signs in suspected heart failure
- Explain a provisional diagnosis and outline appropriate initial management in primary care
- Interpret NT-proBNP results and apply NICE referral thresholds for further investigation
- Describe the role of echocardiography and specialist assessment in confirming heart failure
- Classify heart failure based on ejection fraction and understand its clinical significance
Learning Outcomes
What you'll learn
- Identify key symptoms and clinical features suggestive of heart failure, including typical and less typical presentations
- Differentiate heart failure from other common causes of breathlessness and peripheral oedema
- Recognise underlying causes, risk factors, and precipitating conditions associated with heart failure
- Perform a focused clinical examination and interpret relevant signs in suspected heart failure
- Explain a provisional diagnosis and outline appropriate initial management in primary care
- Interpret NT-proBNP results and apply NICE referral thresholds for further investigation
- Describe the role of echocardiography and specialist assessment in confirming heart failure
- Classify heart failure based on ejection fraction and understand its clinical significance
Modules
Module 1
Recognising Symptoms Suggestive of Heart Failure
Module 2
Differential Diagnosis of Breathlessness and Oedema
Module 3
Underlying Causes and Precipitating Factors
Module 4
Clinical Examination and Key Signs
Module 5
Provisional Diagnosis and Early Primary Care Management
Module 6
Initial Investigations and NT-proBNP Pathway
Module 7
Specialist Assessment and Confirmation of Diagnosis
Module 8
Ejection Fraction and Classification of Heart Failure
Module 9
Summary
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Frequently Asked Questions
Common symptoms include breathlessness, orthopnoea, fatigue, reduced exercise tolerance, and ankle swelling. Less typical symptoms may include cough, dizziness, and confusion, especially in older adults.
Initial tests include NT-proBNP, ECG, chest X-ray, and blood tests. NT-proBNP helps determine the need and urgency for referral for echocardiography and specialist assessment.
No, a definitive diagnosis requires echocardiography to provide objective evidence of cardiac dysfunction, along with specialist interpretation.
NT-proBNP is a marker of cardiac stress. High levels suggest possible heart failure and guide referral, while low levels make heart failure less likely.


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