Samenvatting van de standaard 'Hartfalen' (eerste herziening) van het Nederlands Huisartsen Genootschap

- The guideline entitled ‘Heart failure’ from the Dutch College of General Practitioners has been revised.

- The general practitioner makes the diagnosis of heart failure in a patient with the core symptoms (dyspnoea, fatigue, oedema) in combination with paroxysmal nocturnal dyspnoea, orthopnoea, crepitations, elevated central-venous pressure, a third heart sound or if ictus cordis is visible outside the mid-clavicular line.

- Further investigations include a panel of laboratory investigations, an ECG and possibly echocardiography and radiographic chest investigations. One new recommendation is that on suspicion of heart failure the plasma concentrations of B-type natriuretic peptide (BNP) or N-terminal pro-BNP should be investigated.

- The step-by-step medication plan has been changed; beta-blockers have been introduced to the plan.

- In the treatment of acute heart failure, rapidly working sublingual nitrates should be given first and foremost.

Ned Tijdschr Geneeskd. 2005;149:2668-72