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The Limited Reliability of Physical Signs for Estimating Hemodynamics in Chronic Heart Failure
Abstract
The cardiovascular physical examination is used commonly as a basis for diagnosis and therapy in chronic heart failure, although the relationship between physical signs, increased ventricular filling pressure, and decreased cardiac output has not been established for this population. We prospectively compared physical signs with hemodynamic measurements in 50 patients with known chronic heart failure (ejection fraction, .18 +/- .06). Rales, edema, and elevated mean jugular venous pressure were absent in 18 of 43 patients with pulmonary capillary wedge pressures greater than or equal to 22 mm Hg, for which the combination of these signs had 58% sensitivity and 100% specificity. Proportional pulse pressure correlated well with cardiac index (r = .82), and when less than 25% pulse pressure had 91% sensitivity and 83% specificity for a cardiac index less than 2.2 L/min/m2. In chronic heart failure, reliance on physical signs for elevated ventricular filling pressure might result in inadequate therapy. Conversely, the adequacy of cardiac output is assessed reliably by pulse pressure. Our results facilitate decisions regarding treatment in chronic heart failure.
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2013 ACCF/AHA Guideline for the Management of Heart Failure
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., Fonarow, G. C., Geraci, S. A., Horwich, T., Januzzi, J. L., et al. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.05.019 · Cited by 12,536
Self-citationYancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., Fonarow, G. C., Geraci, S. A., Horwich, T., Januzzi, J. L., et al. (2013) · Circulation · doi:10.1161/cir.0b013e31829e8807 · Cited by 3,304
Self-citationMullens, W., Damman, K., Harjola, V.-P., Mebazaa, A., Brunner-La Rocca, H.-P., Martens, P., Testani, J. M., Tang, W. H. W., Orso, F., Rossignol, P., et al. (2019) · European Journal of Heart Failure · doi:10.1002/ejhf.1369 · Cited by 1,119
Heart Failure With Reduced Ejection Fraction: A Review
Murphy, S. P., Ibrahim, N. E., & Januzzi, J. L. (2020) · JAMA · doi:10.1001/jama.2020.10262 · Cited by 769
Evaluation and management of heart failure with preserved ejection fraction
Borlaug, B. A. (2020) · Nature Reviews Cardiology · doi:10.1038/s41569-020-0363-2 · Cited by 675
Calculated Plasma Volume Status and Prognosis in Chronic Heart Failure
Ling, H. Z., Flint, J., Damgaard, M., Bonfils, P. K., Cheng, A. S., Aggarwal, S., Velmurugan, S., Mendonca, M., Rashid, M., Kang, S., et al. (2015) · European Journal of Heart Failure · doi:10.1002/ejhf.193 · Cited by 130
Extracorporeal Ultrafiltration for Fluid Overload in Heart Failure
Costanzo, M. R., Ronco, C., Abraham, W. T., Agostoni, P., Barasch, J., Fonarow, G. C., Gottlieb, S. S., Jaski, B. E., Kazory, A., Levin, A. P., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.528 · Cited by 125
Metadata
- Authors
- Stevenson, L. W.
- Venue
- JAMA: The Journal of the American Medical Association
- Publisher
- American Medical Association (AMA)
- Published
- 1989-02-10
- Volume
- 261
- Issue
- 6
- Pages
- 884
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2021402962
- Cited by
- 1,025
- References
- 0
- FWCI
- 9.80
- Type
- journal article
- Language
- en
- Open access
- closed
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