How should I manage a patient with suspected heart failure while awaiting echocardiography results?

While awaiting echocardiography results for a patient with suspected heart failure, initial management should include a thorough clinical assessment with history, examination, and baseline investigations such as ECG, chest X-ray, and blood tests including renal, thyroid, liver function, and natriuretic peptides (NT-proBNP) measurement to support diagnosis and severity assessment.

Measure NT-proBNP to stratify urgency: if NT-proBNP is above 2000 ng/L, urgent specialist assessment and echocardiography within 2 weeks is required; if between 400 and 2000 ng/L, echocardiography should be done within 6 weeks.

While awaiting echocardiography, manage symptoms conservatively and consider starting treatment if clinical suspicion is high, especially if signs of fluid overload are present, such as offering diuretics to relieve congestion.

Monitor renal function, weight, and urine output closely during diuretic therapy.

Provide patient education about symptoms to watch for that indicate deterioration and ensure a clear plan for follow-up and access to specialist care if needed.

Do not delay referral for echocardiography and specialist assessment as this is essential for confirming diagnosis and guiding further management.