Chronic heart failure.

1. The common symptoms and signs of chronic heart failure are dyspnoea, ankle swelling, raised jugular venous pressure and basal crepitations. Other conditions may be confused with chronic heart failure, including dependent oedema or oedema due to renal or hepatic disease. Shortness of breath may be due to respiratory disease or severe anaemia. Heart failure secondary to lung disease (cor pulmonale) should be distinguished from congestive cardiac failure. Heart failure may also present with less common symptoms including: cough, anorexia and weight loss, hepatic capsule pain and confusion. 2. Once heart failure is recognized, an attempt should be made to determine the underlying cause which may include valvular abnormalities, altered cardiac rhythm, specific heart muscle disease, coronary artery disease and hypertension. 3. Investigations initiated by the general practitioner include ECG, chest x-ray, full blood count (FBC), mean corpuscular volume (MCV), gamma transferase (GTT), creatinine and electrolytes, thyroxine. 4. If no underlying cause is found then referral should be considered in those under 75 and those aged 75 and over who fail to respond to treatment. 5. It is important to encourage patients to stop smoking, reduce weight and, where appropriate, alcohol consumption. Added salt should be avoided. 6. Digoxin should be prescribed to control the ventricular rate in those with atrial fibrillation. Renal function and potassium should be checked beforehand and the dose of digoxin adjusted to take into account any renal impairment. 7. Bendrofluazide is recommended in doses of not more than 10 mg (5 mg in the elderly). Potassium supplements may be required for those at high risk from hypokalaemia, including patients taking digoxin.(ABSTRACT TRUNCATED AT 250 WORDS)