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clinical link between heart failure, shortness of breath and oedema

Due to the acute nature of the symptoms and the established clinical link between heart failure, shortness of breath and oedema it was essential to perform a 12 lead ECG. A patient suffering heart failure will typically have an abnormal ECG displaying at least three anomalies (Karaye and Sani, 2008). The study found 98.2% of patients studied had ECG abnormalities. While this research was conducted in a developing country, making direct comparison with the UK difficult, the results are significant enough to not be dismissed. In this case the ECG showed a normal sinus rhythm without other irregularities, indicating another cause of the symptoms (Gillespie, 2006).
As the evidence was suggestive of a non-cardiac cause a urinalysis test was conducted. A urinalysis test can help indicate the presence of significant kidney pathology and provides a quick, easy and cost effective measure (Simmerville et al, 2005). A dipstick test is neither the gold standard or without risk of false positives however it serves as a useful tool in a resource scarce environment. The test revealed 3+ of protein and 2+ of blood. Hanno (2012) identified that urinalysis was both specific and sensitive when measuring protein > 2+ making this result highly suggestive of a renal problem. NICE guidelines (2015) regarding chronic kidney disease highlight the asymptomatic nature of the disease indicating that acute symptoms are not necessarily a suggestion of acute pathology. In addition research by Yuste (2015) has identified a previously dismissed pathogenic role of glomerular haematuria, a combination of significant proteinuria and haematuria, in kidney disease.

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