In its 2003 guidance the National Institute for Health and Clinical Excellence (NICE) on heart failure sets out the following sequential
steps to be followed in making a diagnosis of heart failure:
- Take a careful and detailed history, and perform a clinical examination. These should
combined with tests to confirm the presence of heart failure and make a complete diagnosis;
- Seek to exclude a diagnosis of heart failure by using a 12 lead electrocardiogram (ecg) and testing with natriuretic peptides. A person with a
"normal" ecg is unlikely to have heart failure and an abnormal test result with natriuretic peptides is a good indicator that heart failure has occurred.
- The following should be undertaken in order to exclude alternative diagnoses and to evaluate possible aggravating factors;
- chest x-ray
- biochemical profile including electrolytes, urea and creatinine
- full blood count
- thyroid function tests
- liver function tests
- fasting lipids
- fasting glucose
- urinalysis
- peak flow or spirometry
- An electrocardiographic examination should be undertaken by experienced operators who are trained to the "relevant professional standards".
- The reporting of the electrocardiogrphic results should be undertaken by those experienced in doing so. The guidance also states that doctors
may need help in interpreting the ecg results.
