Sometimes it is necessary to refer a person with congestive heart failure to a specialist for evaluation and/or management.


Indications for referral of a patient with heart failure:

(1) diagnosis of heart failure in doubt

(2) when a specialized investigation and management may be helpful to optimize care

(3) significant murmur(s) and valvular heart disease

(4) arrhythmias

(5) secondary heart failure (secondary to thryotoxicosis, etc.)

(6) severe left ventricular impairment (ejection fraction < 20%)

(7) pre-existing or developing metabolic abnormalities and/or renal impairment

(8) severe associated vascular disease

(9) relative hypotension (systolic blood pressure < 100 mm Hg) before starting angiotensin converting enzyme inhibition

(10) poor response to treatment


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