Bedside cardiovascular examination in patients with severe chronic heart failure: Importance of rest or inducible jugular venous distension

Butman, Samuel M.; Ewy, Gordon A.; Standen, James R.; Kern, Karl B.; Hahn, Elizabeth A.

doi:10.1016/0735-1097(93)90405-p

Cited by 256 publications

(100 citation statements)

References 14 publications

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“…The presence of orthopnea and paroxysmal nocturnal dyspnea (PND) are two hallmark symptoms associated with the diagnosis of fl uid overload secondary to AHF. When evaluated more closely in a study of 52 patients with established left ventricular dysfunction, Butman et al (8) showed that only 50 % presented with orthopnea and 35 % with PND. In a meta-analysis of over 22 studies on the diagnosis of CHF performed by Wang et al (9) it was shown that the pooled sensitivities and specifi cities of common symptoms between the studies yielded only modest values for the diagnosis or exclusion of HF.…”

Section: History Assessmentmentioning

confidence: 99%

The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure

Somma¹,

Navarin²,

Giordano³

et al. 2012

Clinical Chemistry and Laboratory Medicine (CCLM)

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The quantitative and qualitative estimation of total body fl uid content has proven to be crucial for both diagnosis and prognosis assessment in patients with heart failure. The aim of this review is to summarize the current techniques for assessing body hydration status as well as the principal biomarkers associated with acute heart failure (AHF). Although clinical history, physical examination and classical imaging techniques (e.g., standard radiography and echocardiography) still represent the cornerstones, novel and promising tools, such as biomarkers and bio-electrical impedance are achieving an emerging role in clinical practice for the assessment of total body fl uid content. In the acute setting, the leading advantages of these innovative methods over device are represented by the much lower invasiveness and the reasonable costs, coupled with an easier and faster application. This article is mainly focused on AHF patients, not only because the overall prevalence of this disease is dramatically increasing worldwide, but also because it is well-known that their fl uid overload has a remarkable diagnostic and prognostic significance. It is thereby conceivable that the bio-electrical vector analysis (BIVA) coupled with laboratory biomarkers might achieve much success in AHF patient management in the future, especially for assisting diagnosis, risk stratifi cation, and therapeutic decision-making.

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Section: History Assessmentmentioning

confidence: 99%

The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure

Somma¹,

Navarin²,

Giordano³

et al. 2012

Clinical Chemistry and Laboratory Medicine (CCLM)

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show abstract

“…The value of symptoms and signs in the diagnosis of CHF has rarely been tested in large numbers of patients representative of those found in the community [2][3][4][5][6][7][8]. Most studies have investigated hospital populations (in-or outpatient referrals), which are a selected group with more severe CHF [2][3][4][5][6][7], a problem identified by the authors.…”

Section: Introductionmentioning

confidence: 99%

“…Most studies have investigated hospital populations (in-or outpatient referrals), which are a selected group with more severe CHF [2][3][4][5][6][7], a problem identified by the authors. The accuracy of clinical diagnosis found in those studies should not be generalized to the whole population.…”

Section: Introductionmentioning

confidence: 99%

The diagnosis of heart failure in primary care: value of symptoms and signs

Fonseca

Morais²,

Mota

et al. 2004

European J of Heart Fail

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Background: The value of symptoms and signs in the diagnosis of CHF has rarely been tested in large numbers of patients in the community. The aim of this study was to evaluate the importance of symptoms, signs, and past medical history in the diagnosis of CHF in primary care. Methods: Data on a sample of Portuguese men and women attending 365 primary care centres for any condition other than the treatment of acute infection, metabolic conditions or pregnancy were collected. All subjects who scored three or more points in the sum of categories one and two of the Boston questionnaire (history and physical examination) and those being treated for heart failure with loop or thiazide diuretics were considered to have possible heart failure and referred for further assessment including a resting echocardiogram. The sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio (LR) for the diagnosis of heart failure were calculated. Results: A total of 5434 subjects were identified, of whom 1058 fulfilled the criteria for further assessment; 551 subjects had cardiac dysfunction at rest, of which 35.5% were in NYHA class I and 4.9% in class IV. Prior use of digoxin (LR 24.9) and/or diuretics (LR 10.6), a history of coronary artery disease (LR 7.1) or of pulmonary oedema (LR 54.2), were associated with a greater likelihood of having heart failure. Amongst current symptoms, a history of paroxysmal nocturnal dyspnoea (LR 35.5), orthopnea (LR 39.1) and breathlessness when walking on the flat (LR 25.8) were associated with a diagnosis of heart failure. However, these symptoms were not frequent amongst patients with heart failure within this population (sensitivity b36%). Jugular pressure N6 cm with hepatic enlargement, and oedema of the lower limbs (LR 130.3), a ventricular gallop (LR 30.0), a heart rate above 110 bpm (LR 26.7), and rales at pulmonary auscultation (LR 23.3) were all associated with a diagnosis of heart failure, but were infrequent findings in patients with heart failure (sensitivity b10%). Conclusions: Symptoms and signs, and clinical history had limited value in diagnosing heart failure when used alone. The signs and symptoms that best predicted a diagnosis of heart failure were those associated with more severe disease. If investigation is limited to patients with more definite symptoms and signs of heart failure, fewer than 50% of cases will be identified and a large number of patients with mild symptoms will be missed.

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“…[1][2][3][4][5][6] Emerging data on serum measurement of B-type natriuretic peptide (BNP), a hormone secreted mainly by the left ventricular (LV) myocardium in CHF, show promise that it may be an important aid to physicians in identifying patients with heart failure and defining outcomes. Levels of BNP may be used as a surrogate marker of decreased ventricular function and increased ventricular filling pressures 7,8 and compare favorably with other surrogate markers of CHF prognosis, such as plasma renin activity and serum norepinephrine.…”

Section: Introductionmentioning

confidence: 99%

B‐type natriuretic peptide measurement in heart failure

Spevack

Schwartzbard

2004

Clinical Cardiology

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SummarySerum testing for the hormone B-type natriuretic peptide (BNP) may have clinical utility in congestive heart failure (CHF). This hormone is secreted predominantly by the left ventricular myocardium in patients with CHF. Measurement of serum BNP may improve diagnosis of CHF and may also help guide therapy in patients with CHF. The literature regarding the clinical utility of BNP measurement in CHF is reviewed.

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Bedside cardiovascular examination in patients with severe chronic heart failure: Importance of rest or inducible jugular venous distension

Cited by 256 publications

References 14 publications

The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure

The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure

The diagnosis of heart failure in primary care: value of symptoms and signs

B‐type natriuretic peptide measurement in heart failure

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