Non-invasive and contemporaneous cardiac imaging in heart failure
This article reviews the current non-invasive cardiac imaging modalities used in the diagnosis and management of heart failure patients. Heart failure is a complex syndrome secondary to functional and structural changes of the heart, with a wide range of possible causes for its onset. Different imaging investigations can inform diagnosis and guide care plans, so nurses across clinical practice will benefit from having knowledge on when these modalities are used. Echocardiography remains the most common investigation due to its low cost and reproducible nature when compared with other methods. It allows quantification of left ventricular function, which is an important prognostic marker in heart failure. Through cardiac magnetic resonance imaging, identification of potential reversible causes is possible, and further identification of underlying causes, when other modalities fail to do so. Finally, computed tomography coronary angiography is the currently recommended test in all patients presenting with typical or atypical anginal symptoms, diagnostically comparable to invasive coronary angiography
Heart failure remains a major public health problem with just under 1 million people in the UK known to be living with it (Conrad et al, 2018). The past 20 years have been marked by important medical advances in diagnostic and treatment options; however, a diagnosis of heart failure carries worse survival outcomes than most common cancers, such as breast, lung, prostate and bladder (Mamas et al, 2017). Heart failure is not a single pathological process, but a chronic and complex clinical syndrome secondary to structural or functional changes of the heart. According to its classical definition (Braunwald, 1988), heart failure is described as the heart's inability to pump blood across the body at the rate needed to match its physiological needs. Any cardiac disease damaging the functional or structural components of the heart has the potential to cause heart failure and identifying the cause is essential to guide decision-making on evidence-based treatment options. The most common contributors to heart failure include coronary artery disease, diabetes, hypertension and obesity. Less common are cardiomyopathies (defined as a disease of the heart muscle affecting size, shape or thickness), infections, toxins and valvular diseases (Groenewegen et al, 2020).
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