Does the physical examination still have a role in patients with suspected heart failure?

Abstract

AimsThe prognostic value of signs of congestion in patients suspected of having chronic heart failure (CHF) is unknown. Our objectives were to define their prevalence and specificity in diagnosing CHF and to determine their prognostic value in patients in a community heart failure clinic. Methods and resultsAnalysis of referrals to a community clinic for patients with CHF symptoms. Systolic CHF (S-HF) was defined as left ventricular ejection fraction (LVEF) ≤45%, heart failure with normal ejection fraction (HeFNEF) as LVEF . 45%, and amino-terminal pro-brain natriuretic peptide .50 pmol L 21 ; other subjects were defined as not having CHF. Signs of congestion were as follows: no signs; right heart congestion (RHC: oedema, jugular venous distension); left heart congestion (LHC: lung crackles); or both (R + LHC). Of 1881 patients referred, 707 did not have CHF, 853 had S-HF, and 321 had HeFNEF. The median inter-quartile range (IQR) age was 72 years (64-78), 40% were women, and LVEF was 47% (35 -59). Overall, 417 patients had RHC of whom 49% had S-HF and 21% HeFNEF. Eighty-five patients had LHC of whom 43% had S-HF and 20% had HeFNEF. One hundred and seventy-two patients had R + LHC of whom 71% had S-HF and 16% had HeFNEF. During a median (IQR) follow-up of 64(44-76) months, 40% of the entire patient cohort died. The combination of R + LHC signs was an independent marker of an adverse prognosis (x 2 -log-rank test ¼ 186.1, P , 0.0001). ConclusionClinical signs of congestion are independent predictors of prognosis in ambulatory patients with suspected CHF.--

Potentially inappropriate use of furosemide in a very elderly population: An observational study

“…Nevertheless, a former study showed that diuretic therapy could safely be withdrawn for a large proportion of very old geriatric patients, regardless of the initial indications, thus protecting them from the above‐mentioned furosemide complications and adverse effects. In addition, congestive signs, especially lower‐limb oedema, are particularly frequent among older patients, but are not specific to HF . It is not always easy to affirm their cardiac origin in ambulatory medicine, because of the limited access to confirmatory diagnostic tools (eg, echocardiography).…”

Prognostic significance of ultrasound-assessed jugular vein distensibility in heart failure

“…Clinical signs of fluid overload are associated with an adverse outcome in patients with heart failure (HF), both in those with reduced and those with normal left ventricular (LV) systolic function, with or without common rhythm disturbances, such as atrial fibrillation (AF)1 2…”

Velcro crackles: the key for early diagnosis of idiopathic pulmonary fibrosis?

“…However, crackles in IPF are heard throughout the entire inspiratory time [29,30]. Adventitious sounds associated with heart failure and pneumonia are higher in frequency and quite distinct from fine crackles of IPF [15,31], and rales are present in only one in four patients with left heart congestion due to systolic heart failure [32].…”