What are the common signs of heart failure exacerbation that I should monitor in my patients?

Common signs of heart failure exacerbation to monitor in patients include:

• Increased shortness of breath or breathlessness.
• New or worsening oedema, especially in the abdomen, sacrum, genitalia, and ankles.
• Weight gain indicating fluid retention.
• Raised jugular venous pressure.
• Fine lung crepitations on auscultation.
• Hepatomegaly (enlarged liver) due to congestion.
• Postural drop in blood pressure greater than 20 mmHg, suggesting hypovolaemia.
• Palpitations or irregular pulse indicating possible arrhythmias.
• Syncope or presyncope symptoms, which may indicate ventricular tachycardia or other serious arrhythmias.
• Reduced functional capacity or worsening ability to perform everyday activities.

Regular assessment of these signs and symptoms is essential for early detection of deterioration and timely management of heart failure exacerbations.

Patients should also be monitored for cognitive status changes and psychosocial needs, as these can be affected during exacerbations.

Clinical examination should include pulse rate and rhythm assessment, and if arrhythmia is suspected, an ECG should be arranged.

Monitoring body weight regularly helps detect fluid overload early.

These monitoring strategies align with NICE and SIGN guidelines for chronic heart failure management in primary care.

References: ¹,²