ABC of heart failure: Clinical features and complications

Watson, R. Douglas; Gibbs, C R; Lip, Gregory Y.H.

doi:10.1136/bmj.320.7229.236

Cited by 138 publications

(108 citation statements)

References 6 publications

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“…Warnings have even been given for the serious limitations of physical examination, 3 and very low univariable positive predictive values of solitary physical examination items have been published in relatively small studies. 28 In the present study, however, pulse rate, pulse regularity, pulmonary rales, displaced apex beat, heart murmur suggestive of mitral regurgitation, and distended jugular veins were all univariably associated with the presence of heart failure and retained that association in the multivariable analyses.…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Value of Physical Examination and Additional Testing in Primary Care Patients With Suspected Heart Failure

et al. 2011

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Background-Early diagnosis of nonacute heart failure is crucial because prompt initiation of evidence-based treatment can prevent or slow down further progression. To diagnose new-onset heart failure in primary care is challenging. Methods and Results-This is a cross-sectional diagnostic accuracy study with external validation. Seven hundred twenty-one consecutive patients suspected of new-onset heart failure underwent standardized diagnostic work-up including chest x-ray, spirometry, ECG, N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement, and echocardiography in specially equipped outpatient diagnostic heart failure clinics. The presence of heart failure was determined by an outcome panel using the initial clinical data and 6-month follow-up data, blinded to biomarker data. Of the 721 patients, 207 (28.7%) had heart failure. The combination of 3 items from history (age, coronary artery disease, and loop diuretic use) plus 6 from physical examination (pulse rate and regularity, displaced apex beat, rales, heart murmur, and increased jugular vein pressure) showed independent diagnostic value (c-statistic 0.83). NT-proBNP was the most powerful supplementary diagnostic test, increasing the c-statistic to 0.86 and resulting in net reclassification improvement of 69% (PϽ0.0001). A simplified diagnostic rule was applied to 2 external validation datasets, resulting in c-statistics of 0.95 and 0.88, confirming the results. Conclusions-In this study, we estimated the quantitative diagnostic contribution of elements of the history and physical examination in the diagnosis of heart failure in primary care outpatients, which may help to improve clinical decision making. The largest additional quantitative diagnostic contribution to those elements was provided by measurement of NT-proBNP. For daily practice, a diagnostic rule was derived that may be useful to quantify the probability of heart failure in patients with new symptoms suggestive of heart failure. (Circulation. 2011;124:2865-2873.)

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Section: Discussionmentioning

confidence: 99%

The Diagnostic Value of Physical Examination and Additional Testing in Primary Care Patients With Suspected Heart Failure

et al. 2011

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“…La sensibilidad y especifi cidad para cada síntoma, signo y examen útiles en el diagnóstico de la IC se revisa en la tabla 1 [13,16,[19][20][21][22][23][24][25][26][27][28][29].…”

Section: ¿Se Despierta Ahogado En La Noche?unclassified

“…Se asocia con alteraciones del músculo esquelético por defi ciencia en el fl ujo sanguíneo, en la función endotelial y en la estructura muscular [21]. Se considera un síntoma predictor de empeoramiento de la IC que tiene especial importancia ya que afecta la calidad de vida del paciente al limitar la actividad física [41,48].…”

Section: ¿Se Despierta Ahogado En La Noche?unclassified

Semiología y diagnóstico diferencial de la insuficiencia cardíaca crónica

Giraldo

Salazar

Buitrago-Toro

et al. 2018

Rev. Médica Risaralda

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Resumen: la insuficiencia cardiaca es un síndrome clínico de etiología multifactorial de alta prevalencia en la población mundial y latinoamericana debido al aumento en la expectativa de vida. Actualmente el diagnóstico de este se basa en los hallazgos de pruebas diagnósticas como el ecocardiograma o pépticos natriuréticos, pero es importante para el personal médico conocer e identificar de manera clara los signos y síntomas que presentan los pacientes con insuficiencia cardiaca, pues es una tendencia actual el desconocer datos semiológicos importantes que fueron descritos y refinados durante los siglos XIX y XX, y que ahora son validados por la medicina basada en la evidencia. Lo anterior cobra importancia pues el papel que debe tener la creciente tecnología no es acabar o desplazar el conocimiento clínico, si no ser una herramienta complementaria para el buen cuidado del paciente y así llegar al mejor desenlace posible.Este artículo pretende brindar datos basados en la evidencia para hacer de la clínica la parte fundamental del proceso diagnóstico y de la relación médico paciente. También intenta ser una guía útil para estudiantes de medicina o médicos que se desenvuelven en sitios con pocos recursos económicos, ya que la elección adecuada de un examen diagnóstico solo puede ser llevada a cabo mediante un buen interrogatorio y examen físico.Palabras clave: insuficiencia cardiaca; Diagnóstico; Signos y Síntomas; Colombia Copyright © Facultad de Ciencias de la Salud de la Universidad Tecnológica de Pereira. 1995-2017. Todos los derechos reservados ® Semiology and differential diagnosis of chronic heart failure Abstract: heart failure is a clinical syndrome with multifactorial etiology of high prevalence in the world and Latin American population due to the increase in life expectancy. Currently the diagnosis of this is based on the findings of diagnostic tests such as echocardiogram or natriuretic peptic, but it is important for the medical staff to know and clearly identify the signs and symptoms that patients with heart failure present, as it is a current trend To ignore important semiological data that were described and refined during the nineteenth and twentieth centuries, and which are now validated by evidencebased medicine. This is important because the role of growing technology is not to end or displace clinical knowledge, if not to be a complementary tool for good patient care and thus reach the best possible outcome.This article aims to provide data based on the evidence to make the clinic the fundamental part of the diagnostic process and the patient medical relationship. It is also intended to be a useful guide for medical students or physicians operating in poorly funded areas, as the proper choice of a diagnostic examination can only be carried out through a thorough examination and physical examination.Key words: heart failure; Diagnosis; Signs and Symptoms; Colombia Copyright © Facultad de Ciencias de la Salud de la Universidad Tecnológica de Pereira. 1995-2017. All rights reserved ®. Introducc...

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“…[1][2][3] end-stage hF is the final common pathway of a process of myocardial cell death triggered by varied etiologies and characterized by myocardial dysfunction and inadequate remodeling. it is a complex and heterogeneous entity with multiple etiologies, from cardiomyopathy (CM) of ischemic origin that can improve with restoration of myocardial perfusion to other infectious, inflammatory or infiltrative processes that are less responsive to current medical treatments.…”

Section: Introductionmentioning

confidence: 99%