Summary of the practice guideline 'Heart failure' (first revision) from the Dutch College of General Practitioners
van Lieshout, J.; Rutten, F.H.; Walma, E.P.; Wiersma, T.; Goudswaard, A.N.
Nederlands Tijdschrift Voor Geneeskunde 149(48): 2668-2672
2005
ISSN/ISBN: 0028-2162 PMID: 16358616 Document Number: 590048
The guideline entitled 'Heart failure' from the Dutch College of General Practitioners has been revised. The general practitioner makes the diagnosis of heart failure in a patient with the core symptoms (dyspnoea, fatigue, oedema) in combination with paroxysmal nocturnal dyspnoea, orthopnoea, crepitations, elevated central-venous pressure, a third heart sound or ifictus cordis is visible outside the mid-clavicular line. Further investigations include a panel of laboratory investigations, an ECG and possibly echocardiography and radiographic chest investigations. One new recommendation is that on suspicion of heart failure the plasma concentrations of B-type natriuretic peptide (BNP) or N-terminal pro-BNP should be investigated. The step-by-step medication plan has been changed; beta-blockers have been introduced to the plan. In the treatment of acute heart failure, rapidly working sublingual nitrates should be given first and foremost.