title: Difficulties in the diagnosis of heart failure in patients with comorbidities.
abstract: Heart failure (HF) patients present frequently comorbidities and the diagnosis of HF in this setting is a challenge. The symptoms and signs of HF may be atypical and can be simulated or disguised by co-morbidities such as respiratory disease and/or obesity. For this reasons, confirmation of the diagnosis always requires further tests. Natriuretic peptides accurately exclude cardiac dysfunction as a cause of symptoms, but the optimal cut-off levels for ruling out and ruling in HF diagnosis are influenced by different co-morbidities. Echocardiography should be performed in all patients to confirm the diagnosis of HF, except in those cases with low clinical probability and a concentration of brain natriuretic peptides below the exclusion cut-off. This review aims to provide a practical clinical approach for the diagnosis of HF in patients with comorbidity, focusing in older patients and patients with chronic obstructive pulmonary disease and/or obesity.
authors.affiliation: Servicio de Medicina Interna, Hospital de Olot (Girona), Universitat de Girona, Girona, España. Electronic address: jctv5153@comg.cat.
authors.forename: J C
authors.initials: JC
authors.lastname: Trullàs
authors.affiliation: Servicio de Medicina Interna, Hospital de Getafe, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Casado
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova , Lleida, España.
authors.forename: J L
authors.initials: JL
authors.lastname: Morales-Rull
keywords: Comorbidity; Comorbilidad; Diagnosis; Diagnóstico; Heart failure; Insuficiencia cardiaca; Natriuretic peptides; Péptidos natriuréticos