Utility of physical examination and comparison to echocardiography for cardiac diagnosis

Patel, Ashish; Tomar, Nitin Singh; Bharani, Anil

doi:10.1016/j.ihj.2016.07.020

Cited by 15 publications

(18 citation statements)

References 22 publications

(25 reference statements)

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“…7 The stethoscope, a 200 year old device discovered by Dr Laennec, remains the solo screening tool for valvular abnormalities. 10,11 Yet the amount of information that can be gained through auscultation is not comparable to that of the ultrasound. 12 Expert cardiologists still experience the limitation of auscultation when it comes to confidently diagnosing valvular abnormalities.…”

Section: Current Screening Methods For Valvular Heart Disease -A Romentioning

confidence: 99%

“…There are no clear recommendations about who and how to screen by neither the American college of cardiology, nor American heart association 7 . The stethoscope, a 200 year old device discovered by Dr Laennec, remains the solo screening tool for valvular abnormalities 10,11 . Yet the amount of information that can be gained through auscultation is not comparable to that of the ultrasound 12 .…”

Section: Current Screening Methods For Valvular Heart Disease ‐ a Roomentioning

confidence: 99%

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Point‐of‐care ultrasound: Closing guideline gaps in screening for valvular heart disease

Hammadah

Ponce

Sorajja

et al. 2020

Clinical Cardiology

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Background: A linear increase in the number of valvular heart disease is expected due to the aging population, yet most patients with severe valvular heart disease remain undiagnosed. Hypothesis: POCUS can serve as a screening tool for valvular heart disease. Methods: We reviewed the literature to assess the strengths and limitations of POCUS in screening and diagnosing valvular heart disease. Results: POCUS is an accurate, affordable, accessible, and comprehensive tool. It has a fast learning curve and can prevent unnecessary and more expensive imaging. Challenges include training availability, lack of simplified screening protocols, and reimbursement. Large scale valvular screening data utilizing POCUS is not available. Conclusion: POCUS can serve as a screening tool and guide the management of patients with valvular heart disease. More data is needed about its efficacy and costeffectiveness in the screening of patients with valvular heart disease.

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Section: Current Screening Methods For Valvular Heart Disease -A Romentioning

confidence: 99%

Section: Current Screening Methods For Valvular Heart Disease ‐ a Roomentioning

confidence: 99%

Point‐of‐care ultrasound: Closing guideline gaps in screening for valvular heart disease

Hammadah

Ponce

Sorajja

et al. 2020

Clinical Cardiology

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“…Auscultation has moderate-to-low inter-rater reliability and diagnostic accuracy. 42,43 Therefore, the committee agreed that point-of-care ultrasonographic evidence of new aortic regurgitation in a patient presenting with symptoms suggestive of AAS is a highrisk examination finding, in addition to auscultation of a murmur consistent with aortic regurgitation. The use of point-ofcare ultrasound is meant to augment physical examination; therefore, if a provider is not trained in its use, it is simply omitted from pretest probability assessment.…”

Section: High Pretest Probabilitymentioning

confidence: 99%

Diagnosing acute aortic syndrome: a Canadian clinical practice guideline

Ohle

Yan

Yadav

et al. 2020

CMAJ

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cute aortic syndrome (AAS) is a life-threatening emergency, accounting for 1/2000 presentations of acute chest or back pain to the emergency department. 1 It is a clinical spectrum of diagnoses including aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer at any location along the aorta. 1 The incidence of AAS is about 3 per 100 000 persons. 2,3 Many physicians do not consider AAS in their initial differential diagnosis, which is in part why 25% of patients with AAS are not diagnosed with the condition until 24 hours after presenting to the emergency department. 4 Prognosis is most favourable when patients are treated early, while they are clinically stable. Mortality follows a linear increase with diagnostic delay and can be as high as 2% per hour of delay. 5 The misdiagnosis rate during the initial emergency department visit for AAS (i.e., patient admitted for an alternative diagnosis and later diagnosed as AAS; discharged from the emergency department and presenting again with a diagnosis of AAS; or diagnosed on postmortem examination) is estimated to be as high as 38%. 4,6-16 Patients with suspected AAS are typically investigated with electrocardiogram (ECG)-gated contrast-enhanced computed tomography (CT). 2 Current use of this investigation in patients with a clinical suspicion for AAS is inefficient. 17,18 The unnecessary use of CT leads to a direct increase in health care costs but also an increase in contrast-associated complications (e.g., allergic reactions), increased length of emergency department stay or incidental findings requiring further follow-up, additional im aging and increased stress or anxiety for the patient. 17 Use of CT in a low-prevalence population can result in an increase in false-positives, which can lead to further testing, unnecessary transfer and even surgical intervention. 19 There are 2 high-quality guidelines related to the diagnosis of AAS, from the American Heart Association (2010) and the European Society of Cardiology (2014). 20,21 However, there is still considerable variation in how clinicians investigate for AAS in Canada. 17 This variation is likely multifactorial but may be a result of lack of key stakeholder involvement in the development of the guidelines or the difference in threshold for investigation within the Canadian health care system. 22,23 The aims of this guideline are to update the available guideline recommendations with current evidence; include key stakeholders to allow interpretation of the evidence in context of values and preferences; and make practice recommendations that are applicable to the Canadian health care system. The full guideline, including supplemental documents, is available at Appendix 1

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“…We conducted this study to assess the accuracy of clinical diagnosis of congenital heart diseases made by the post graduate student by comparing it with echocardiography. Various studies have been done in children and adults where clinical judgment was compared with the echocardiography for diagnosis of various cardiac disorders [12,13,14,15]. We studied80 cases ofcongenital heart diseases from 1 month to 12 years of age.…”

Section: Discussionmentioning

confidence: 99%

Clinical accuracy of post graduate student in diagnosing congenital heart diseases (CHD) using an algorithmic approach and its comparison with echocardiography

Mehta¹,

Bhalse²

2018

Int J Pediatr Res

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Background: Congenital heart diseases (CHDs)are an important cause of morbidity and mortality in children. In view of poor availability of resources in developing nations like India, clinical evaluation of children with CHD is important. Aim: To study the clinical accuracy of post graduate student in diagnosing congenital heart diseases and its comparison with echocardiography. Subjects and Methods: A prospective cross-sectional study performed in the Department ofPediatrics of a tertiary level teaching hospital in central India. Participants were children with CHDs attending outpatient department or admitted in wards or PICU. History, general physical and cardiovascular examinations were recorded by the post graduate student. Chest X-ray and ECG were obtained. These findings were used to classify the defect using an algorithm and a clinical diagnosis was made which was matched with echocardiography.Kappa coefficient test was used to judge the degree of agreement between the two methods. Results: 80 patients with CHDs were included in the final analysis. 49 (61.25%) had acyanotic CHDs and ventricular septal defect (VSD) was the most common defect (n= 24, 30%) while tetralogy of Fallot (TOF) was the most common (n=14, 17.5%) cyanotic CHD. Concordance of clinical diagnosis and echocardiography was maximum for VSD (16/24, 66.6%) in acyanotic group and TOF (8/14, 57%) in cyanotic group. Kappa's coefficient test analysis also showed an "almost perfect" area of agreement for VSD (κ=0.87) and fair area of agreement for TOF (κ=0.65). For type of CHD (cyanotic or acyanotic) and type of ventricular hypertrophy (left, right or biventricular) it showed "almost perfect" and"fair" area of agreement respectively. Conclusion: Agreement between echocardiography and cclinical diagnosis of CHDs including hemodynamic parameters like type of ventricular hypertrophy and pulmonary arterial hypertension was reasonably accurate in our study.

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Utility of physical examination and comparison to echocardiography for cardiac diagnosis

Cited by 15 publications

References 22 publications

Point‐of‐care ultrasound: Closing guideline gaps in screening for valvular heart disease

Point‐of‐care ultrasound: Closing guideline gaps in screening for valvular heart disease

Diagnosing acute aortic syndrome: a Canadian clinical practice guideline

Clinical accuracy of post graduate student in diagnosing congenital heart diseases (CHD) using an algorithmic approach and its comparison with echocardiography

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