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[Diagnosis of systolic heart failure]
Xavier André-Fouët1, Isabelle Ginon, Sophie Thivolet
1Service de cardiologie D Hôpital cardio-vasculaire et pneumologique Louis-Pradel BP Lyon Montchat 69394 Lyon. xavier.andre-fouet@chu-lyon.fr
Insights
Diagnosing heart failure involves recognizing systolic and diastolic dysfunction. Key diagnostic tools include physical exams, B-type natriuretic peptide tests, and Doppler echocardiography for assessing left ventricular function.
Area of Science:
- Cardiology
- Internal Medicine
Context:
- Heart failure frequently involves left ventricular systolic dysfunction, often accompanied by diastolic dysfunction.
- Clinical presentation and physical examination aid in the presumptive diagnosis of heart failure.
- Specific signs like cardiac impulse deviation and protodiastolic gallop suggest systolic heart failure.
Purpose:
- To outline the diagnostic approach for heart failure, emphasizing systolic dysfunction.
- To highlight the utility of various diagnostic modalities in heart failure assessment.
Summary:
- Clinical manifestations and physical findings can suggest heart failure, with specific signs pointing towards systolic dysfunction.
- Bedside B-type natriuretic peptide measurement assists in diagnosing or excluding heart failure in acute dyspnea.
- Doppler echocardiography is crucial for confirming left ventricular systolic dysfunction and identifying its cause (ischemic, valvular, myocardial).
Impact:
- Accurate diagnosis of heart failure and its underlying mechanisms is essential for effective management.
- Doppler echocardiography provides objective assessment of left ventricular systolic function, surpassing visual estimation.
- Coronary angiography is indicated for unclear heart failure mechanisms when revascularization is a potential treatment option.
Abstract:
Most of patients with heart failure present a left ventricular systolic dysfunction usually, if not always, associated with a diastolic dysfunction. Clinical manifestations and physical examination allows a presumed diagnosis. Some signs guide toward a systolic heart failure: deviation of cardiac impulse, protodiastolic gallop, functional mitral insufficiency, radiological cardiomegaly associated with signs of postcapillary hypertension, anterior Q wave or complete left bundle branch block. Bed-side dosage of B-type natriuretic peptide is useful to make or exclude the diagnosis of heart failure in patients with acute dyspnea from various causes. Doppler echocardiography is essential to confirm the left ventricular systolic dysfunction and its mechanism: ischemic, valvular or myocardial. The value of shortening fraction is better than eye evaluation. Coronary angiography is indicated when the mechanism of heart failure is unclear and if the patient is relevant to revascularization.