If failure is present, a trial of loop diuretics such as frusemide is indicated. If nocturia is related to heart failure, a morning loop diuretic will normally relieve the symptom. Most cardiologists would recommend an echocardiogram to exclude valvular heart disease and atrial myxoma and to assess LV function. In most cases, the diagnosis will be CCF due to ischaemic heart disease. Key points Classical symptoms as outlined in the NYHA classification of heart failure are easy to recognise However, heart failure can present in less obvious ways Doctors should therefore have a high index of suspicion of heart failure, especially if there is a record of angina, myocardial infarction, an enlarged heart on chest X-ray or ischaemic changes on the ECG Advanced CCF A patient with known heart failure can present with poor appetite and weight loss.
Patients sometimes complain of a feeling of fullness immediately after swallowing food.
Some patients have discomfort on lying on the left side. This symptom can be due to the weight of a large congested liver compressing the stomach. Enlarged stomach veins impair absorption and may contribute to loss of appetite and indigestion. Differentiating these symptoms from digoxin toxicity may be extremely difficult. A normal plasma level of digoxin may be an indication for cautiously increasing the dose of diuretic.