Letters Investigating suspected heart failure

Authors’ reply to Davie and to Broughton and colleagues

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3565 (Published 04 June 2013) Cite this as: BMJ 2013;346:f3565
  1. Kevin Fox, consultant cardiologist1,
  2. Tushar Kotecha, cardiology specialist registrar1
  1. 1Imperial College Healthcare NHS Trust, London W6 8RF, UK
  1. k.fox{at}imperial.ac.uk

Davie’s suggestion of a therapeutic trial may be useful and has been used formerly as part of a diagnostic strategy.1 2 3 But we would caution against relying on the response to furosemide because this drug reduces oedema from any cause, whereas non-cardiac oedema will not respond to angiotensin converting enzyme inhibitors. However, the use of B-type natriuretic peptide and echocardiography provides—in addition to diagnosis—prognostic, aetiological, and therapeutic information.

There are several possible investigations for coronary disease and an individualised approach is recommended. …

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