**5. Issues of differential diagnosis of signs and symptoms of HF**

To begin differential diagnosis of manifestations similar to SN, you should always ask whether there is a reason for its development and whether the patient has a disease that can explain the manifestations. For example, if a patient has atrial fibrillation, the occurrence of shortness of breath after the development of a rhythm disorder should be explained by heart failure. And if a patient without heart disease has anemia, then shortness of breath is probably due to this cause.

But it is not necessary for a patient with heart disease to have shortness of breath only of cardiac origin. It should be mentioned once again that in every third case among outpatient visitors, who had a cardiovascular disease, HF is falsely diagnosed. And among women, this is 2 times more common than among men.

We found that most of the patients with cardiovascular disease and misdiagnosed heart failure suffer from anxiety disorders (53%). Second place is taken by obesity (39%). Then among the causes are decrepitude, pathologies of the respiratory system and anemia. There is no doubt that the patient may have different causes of symptoms.

#### *Features of Diagnostics and Differential Diagnostics of Chronic Heart Failure in Outpatient… DOI: http://dx.doi.org/10.5772/intechopen.95863*

For example, a patient with arterial hypertension and obesity may have severe anxiety and lack of training. Such a patient has a pathological circle, when anxiety for their health leads to the fact that they move less and eat more, and the increasing weight further restricts their physical abilities. These patients often have shortness of breath, oedema, enlarged liver, and arterial hypertension as a possible cause of HF. In addition, their EF remains normal, and NT-proBNP increases slightly even in the presence of HF. The cause of edema in them may be a violation of venous outflow due to obesity, or, perhaps, taking calcium antagonists, hepatomegaly is caused by non-alcoholic steatohepatitis, and shortness of breath is associated with a large body weight and lack of training.

Outpatient patients with heart failure usually have several comorbidities. So, on average, there are an additional 2.5 diseases per patient with HF. It should be noted that anxiety and depression are frequent companions of patients with HF. According to our data, 22% of outpatient patients with HF have depression, and 53% have severe anxiety.

It is necessary to distinguish between dyspnea that occurs with myocardial ischemia and dyspnea caused by HF, because dyspnea caused by ischemia is treated by restoring myocardial nutrition, and dyspnea in HF requires treatment of HF itself. If there are reasonable suspicions of an ischemic origin of dyspnea, then CT-coronary angiography should be performed.

How, then, can we distinguish HF from other causes of symptoms? To do this, you need to start treating the identified suspected cause of symptoms and evaluate the dynamics. In any case, this should be done, because if we only deal with HF without correcting comorbidities, we will not get a good clinical dynamic. But if the symptoms were associated only with extra-cardiac pathology, then we will get a brilliant result without the use of medications for HF.
