Avaliação hemodinâmica na insuficiência cardíaca: papel do exame físico e dos métodos não invasivos

Abstract

Among the cardiovascular diseases, heart failure (HF) has a high rate of hospitalization, morbidity and mortality, consuming vast resources of the public health system in Brazil and other countries. The correct determination of the filling pressures of the left ventricle by noninvasive or invasive assessment is critical to the proper treatment of patients with decompensated chronic HF, considering that congestion is the main determinant of symptoms and hospitalization. Physical examination has shown to be inadequate to predict the hemodynamic pattern. Several studies have suggested that agreement on physical findings by different physicians is small and that, ultimately, adaptive physiological alterations in chronic HF mask important aspects of the physical examination. As the clinical assessment fails to predict hemodynamic aspects and because the use of Swan-Ganz catheter is not routinely recommended for this purpose in patients with HF, noninvasive hemodynamic assessment methods, such as BNP, echocardiography and cardiographic bioimpedance, are being increasingly used. The present study intends to carry out, for the clinician, a review of the role of each of these tools when defining the hemodynamic status of patients with decompensated heart failure, aiming at a more rational and individualized treatment.

Hemodynamic differences among hypertensive patients with and without heart failure using impedance cardiography

“…Over the last decade, non-invasive hemodynamic assessment methods including ICG, echocardiography, brain natriuretic peptide (BNP) or lung ultrasound have been increasingly used. 4,5 ICG enables continuous, beat-by-beat, operator-independent cardiac output (CO) monitoring in medical or surgical patients.…”

“…In HF monitoring, ICG presented hemodynamic results comparable with those obtained by cardiac magnetic resonance 13 and good correlation with invasive methods determinations (notably the Swan-Ganz catheter), with correlation coefficients between 0.76 and 0.89. 4,14…”

“…In the majority of cases, clinical history and physical examination are not enough for a personalized therapeutic intervention and the proper stratification of the prognosis of HF patients. 4,15,20 Hemodynamic monitoring, particularly the assessment of CO, stroke volume, and left ventricular filling pressures are useful when selecting an appropriate approach of these patients, considering that pulmonary congestion is the main determining factor of symptoms and hospitalization. However, at the current time, there are no clear indications regarding therapy based on hemodynamic measurements and their criteria values, which limits the possibilities for using ICG in clinical practice.…”

A Prompt Diagnosis of Superior Vena Cava Obstruction Established by Physical Examination

“…While physical examination has many disadvantages, such as low sensitivity, insufficient reliability, and lack of reproducibility, it has the advantages of being noninvasive, time-saving, and economical (3). Physical examination can be performed anytime, anyplace, and many times over.…”

“…Therefore, it plays an important role in monitoring the changes of pathophysiology in real time. Although a comprehensive and non-selective compilation of physical signs is no longer considered useful (4), selected physical examination can provide definite signs of a disease with good specificity, quantitative evaluation of the disease (3), and thus sometimes make it possible to make a "snap diagnosis" in a short time (5). One study reported that among patients newly admitted to an internal medicine department, 20% could be correctly diagnosed at admission based on the medical history alone and 40% with the combination of history and physical examination (6).…”