Cross sectional study of contribution of clinical assessment and simple cardiac investigations to diagnosis of left ventricular systolic dysfunction in patients admitted with acute dyspnoea

Abstract

Objective: To assess correlation between type of breast cyst and risk of breast cancer in women with gross cystic disease of the breast. Design: Cohort study of women with breast cysts aspirated between 1983 and 1993 who were followed up until December 1994 for occurrence of breast cancer. Setting: Major cancer prevention centre. Subjects: 802 women with aspirated breast cysts. Main outcome measures: Type of breast cyst based on cationic content of cyst fluid: type I (potassium:sodium ratio > 1.5), type II (potassium:sodium ratio < 1.5), or mixed (both types). Subsequent occurrence and type of breast cancer. Results: After median follow up of six years (range 2-12 years) 15 cases of invasive breast cancer and two ductal carcinomas in situ were diagnosed in the cohort: 12 invasive cancers (and two carcinomas in situ) among the 417 women with type I cysts, two cancers among the 325 women with type II cysts, and one among the 60 women with mixed cysts. The incidence of breast cancer in women with type I cysts was significantly higher than that in women with type II cysts (relative risk 4.62 (95% confidence interval 1.26 to 29.7)). These results were confirmed after adjustment for several risk factors for breast cancer (relative risk 4.24 (1.12 to 27.5)). Conclusions:The increased risk of breast cancer of women with breast cysts seems to be concentrated among women with type I breast cysts.

National Heart, Lung, and Blood Institute Working Group on Emergency Department Management of Acute Heart Failure

“…The current lack of data and consensus regarding appropriate ED diagnosis, treatment goals, and metrics creates disagreement among caregivers. Acute heart failure syndrome is a challenging diagnosis, because its dominant symptom of dyspnea is nonspecific, the physical examination is insensitive (6,7), electrocardiograms are inaccurate (8,9), and chest X-ray findings are unreliable (10 -12). Even when diagnostic certainty exists, evidence-based ED management options are limited, because few prospective ED interventional AHFS studies have been conducted.…”

Primärdiagnostik der Herzinsuffizienz in Klinik und Praxis

“…Ein normales Ruhe-EKG hat einen sehr hohen negativen prädiktiven Wert (> 90%) zum Ausschluss einer linksventrikulären systolischen Dysfunktion [4]. Q-Zacken in den linkspräkordialen Ableitungen oder ein kompletter Linksschenkelblock bei bekannter koronarer Herzkrankheit gehen häufig mit einer eingeschränkten Pumpfunktion einher [17].…”

Basic transthoracic echocardiography

“…In accordance with NICE (National Institute for Health and Clinical Excellence) guidelines,3 this is often requested when patients have symptoms suggesting heart failure. Although clinical information and basic investigations will often identify patients with significant left ventricular systolic dysfunction,4 – 6 echocardiography can quantify the severity and determine the underlying cause. Many patients with heart failure have concomitant or predominant diastolic dysfunction,7 8 which may be more difficult to detect clinically but should be suspected in patients with evidence of heart failure but normal systolic function, particularly elderly people and those with hypertension.…”