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Can the clinical examination diagnose left-sided heart failure in adults?
R G Badgett1, C R Lucey, C D Mulrow
1Department of Medicine, University of Texas Health Science Center at San Antonio and Audie L. Murphy Memorial Veterans Hospital, 78284-7879, USA. Badgett@uthscsa.edu
Insights
Clinicians struggle to accurately diagnose left-sided heart failure types. Key findings for increased filling pressure and systolic dysfunction vary in detection accuracy, impacting treatment.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Left-sided heart failure diagnosis is crucial for effective treatment.
- Accurate differentiation between systolic and diastolic dysfunction is essential.
- Clinical assessment of heart failure findings shows significant variability.
Purpose of the Study:
- To systematically review the literature on the accuracy of clinical determination of left-sided heart failure probability and type.
- To identify the most reliable clinical findings for diagnosing systolic and diastolic heart failure.
Main Methods:
- Systematic literature review.
- Analysis of clinical findings associated with left ventricular ejection fraction and filling pressures.
- Evaluation of diagnostic accuracy for specific heart failure phenotypes.
Main Results:
- Jugular venous distention and radiographic redistribution are key indicators of increased filling pressure.
- Abnormal apical impulse, cardiomegaly, and ECG abnormalities (Q waves, LBBB) best detect systolic dysfunction.
- Diastolic dysfunction diagnosis is challenging, but elevated blood pressure is an associated finding.
Conclusions:
- Clinical detection of left-sided heart failure types, particularly diastolic dysfunction, remains inconsistent.
- Specific clinical signs offer better diagnostic utility for systolic dysfunction and elevated filling pressures.
- Improved diagnostic strategies are needed to enhance the accuracy of heart failure phenotyping in clinical practice.
Abstract:
We systematically reviewed the literature to ascertain how well clinicians determine the probability and type of left-sided heart failure in their patients. Left-sided heart failure is characterized by decreased left ventricular ejection fraction or increased filling pressure. The type of heart failure determines optimal treatment. Systolic dysfunction exists when ejection fraction is reduced. Diastolic dysfunction is presumed to be present when filling pressure is increased with a normal ejection fraction and without another explanatory diagnosis. Many findings are associated with heart failure, and wide variation exists in clinicians' ability to detect these findings. The best findings for detecting increased filling pressure are jugular venous distention and radiographic redistribution. The best findings for detecting systolic dysfunction are abnormal apical impulse, radiographic cardiomegaly, and q waves or left bundle branch block on an electrocardiogram. Diastolic dysfunction is especially difficult to diagnose, but is associated with an elevated blood pressure during heart failure.