Cardiology · Naas, Co. Kildare
Heart Failure Assessment & Management
Comprehensive evaluation of heart failure including echocardiography, biomarker testing and optimisation of medical therapy. HFrEF and HFpEF specialist care.
Cardiology · Naas, Co. Kildare
Comprehensive evaluation of heart failure including echocardiography, biomarker testing and optimisation of medical therapy. HFrEF and HFpEF specialist care.
Overview
Heart failure is a clinical syndrome in which the heart is unable to pump sufficient blood to meet the body's demands, or can only do so at elevated filling pressures. Despite its serious-sounding name, heart failure does not mean the heart has stopped — rather, it is working less effectively than it should, producing a characteristic cluster of symptoms.
The condition is classified primarily by left ventricular ejection fraction (LVEF) — the percentage of blood the heart pumps out with each beat. Heart failure with reduced ejection fraction (HFrEF, LVEF below 40%) and heart failure with preserved ejection fraction (HFpEF, LVEF at or above 50%) represent distinct phenotypes with different underlying mechanisms and, in some respects, different treatment approaches.
Symptoms typically include breathlessness — initially on exertion, progressing to breathlessness at rest or when lying flat — ankle and leg swelling, fatigue and reduced exercise tolerance. However, these symptoms are non-specific, and accurate diagnosis requires clinical assessment combined with echocardiography and biomarker testing.
This page is for educational purposes only and does not constitute medical advice. Consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999 or 112.
Seek urgent medical attention if you experience: sudden severe breathlessness at rest, inability to lie flat, very rapid weight gain over a few days, or new severe leg swelling. These may indicate acute decompensation of heart failure and require immediate hospital assessment.
| NYHA Class | Functional Description |
|---|---|
| Class I | No symptoms with ordinary physical activity |
| Class II | Mild symptoms — comfortable at rest, slight limitation on exertion |
| Class III | Marked limitation — comfortable at rest, symptomatic with minimal activity |
| Class IV | Symptoms at rest — unable to carry out any physical activity without discomfort |
Diagnosis & Investigation
Accurate diagnosis is essential before initiating treatment. A combination of clinical assessment, echocardiography and biomarker testing provides the foundation. Dr Kalyar will review any previous investigations and arrange further tests as needed to establish the diagnosis, phenotype and aetiology of heart failure.
Cardiac ultrasound is the cornerstone of heart failure assessment. It measures ejection fraction, assesses valve function, identifies wall motion abnormalities, and evaluates filling pressures and diastolic function.
Brain natriuretic peptides are released by the heart under stress. Elevated levels strongly suggest heart failure and are used to guide diagnosis, risk stratification and monitoring of treatment response.
A resting ECG identifies arrhythmias, conduction defects and left ventricular hypertrophy. A chest X-ray may show cardiomegaly and pulmonary oedema consistent with decompensated heart failure.
Full blood count, renal function, electrolytes, liver function, thyroid function, iron studies and HbA1c help identify reversible contributing conditions and monitor for treatment side effects.
Management
Heart failure management has been transformed in recent years by the advent of evidence-based therapies that improve symptoms, reduce hospitalisations and extend life. For HFrEF in particular, guideline-directed medical therapy (GDMT) includes four pillars of treatment. Dr Kalyar will assess your current therapy and work systematically to optimise doses within the limits of your blood pressure, renal function and tolerance.
The four pillars of HFrEF therapy comprise an ACE inhibitor or ARNi, a beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor. Each has independent mortality benefit and together produce additive improvements in outcomes.
Heart failure with preserved ejection fraction is an area of evolving evidence. SGLT2 inhibitors have demonstrated benefit. Management also focuses on controlling contributing conditions including hypertension, atrial fibrillation, obesity and diabetes.
Regular review is essential to up-titrate therapy, monitor renal function and electrolytes, assess symptoms and functional capacity, and detect early decompensation. BNP trends guide therapy intensity.
Patients with severe HFrEF may benefit from implantable cardioverter-defibrillator (ICD) or cardiac resynchronisation therapy (CRT). Where indicated, Dr Kalyar will refer to a tertiary centre for device assessment.
Common Questions
Consultant-led heart failure assessment and medical therapy optimisation with Dr Imtiaz Ali Kalyar. Sunday clinics available. Naas, Co. Kildare.
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