Journal ArticleDOI
The Limited Reliability of Physical Signs for Estimating Hemodynamics in Chronic Heart Failure
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TLDR
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.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. (JAMA1989;261:884-888)read more
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Journal ArticleDOI
2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Clyde W. Yancy,Mariell Jessup,Biykem Bozkurt,Javed Butler,Donald E. Casey,Mark H. Drazner,Gregg C. Fonarow,Stephen A. Geraci,Tamara B. Horwich,James L. Januzzi,Maryl R. Johnson,Edward K. Kasper,Wayne C. Levy,Frederick A. Masoudi,Patrick E. McBride,John J.V. McMurray,Judith E. Mitchell,Pamela N. Peterson,Barbara Riegel,Flora Sam,Lynne W. Stevenson,W.H. Wilson Tang,Emily J. Tsai,Bruce L. Wilkoff +23 more
TL;DR: In this article, Anderson et al. proposed a new FAHA Chair, Jeffrey L. Anderson, MD, FACC, FAHA, Chair-Elect, Alice K. Jacobs et al., this article and Biykem Bozkurt.
Journal ArticleDOI
Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology.
Karl Swedberg,John G.F. Cleland,Henry J. Dargie,Helmut Drexler,Ferenc Follath,Michel Komajda,Luigi Tavazzi,Otto A. Smiseth,Antonello Gavazzi,Axel Haverich,Arno W. Hoes,Tiny Jaarsma,Jerzy Korewicki,Samuel Lévy,Cecilia Linde,José-Luis López-Sendón,Markku S. Nieminen,Luc Pierard,Willem J. Remme +18 more
TL;DR: Recent surveys of Guidelines and Expert Consensus Documents published in peer-reviewed journals between 1985 and 1998 have shown that methodological standards were not complied with in the vast majority of cases.
Journal ArticleDOI
ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM).
Kenneth Dickstein,Alain Cohen-Solal,Gerasimos Filippatos,John J.V. McMurray,Piotr Ponikowski,Philip A. Poole-Wilson,Anna Strömberg,Dirk J. van Veldhuisen,Dan Atar,Arno W. Hoes,Andre Keren,Alexandre Mebazaa,Markku S. Nieminen,Silvia G. Priori,Karl Swedberg,Alec Vahanian,John Camm,Raffaele De Caterina,Veronica Dean,Christian Funck-Brentano,Irene Hellemans,Steen Dalby Kristensen,Keith McGregor,Udo Sechtem,Sigmund Silber,Michal Tendera,Petr Widimsky,José Luis Zamorano,Angelo Auricchio,Jeroen J. Bax,Michael Böhm,Ugo Corrà,Paolo Della Bella,Perry M. Elliott,Ferenc Follath,Mihai Gheorghiade,Yonathan Hasin,Anders Hernborg,Tiny Jaarsma,Michel Komajda,Ran Kornowski,Massimo F Piepoli,Bernard Prendergast,Luigi Tavazzi,Jean Luc Vachiery,Freek W.A. Verheugt,Faiez Zannad +46 more
Journal ArticleDOI
Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.
Alan S. Maisel,Padma Krishnaswamy,Richard M. Nowak,James McCord,Judd E. Hollander,Philippe Duc,Torbjørn Omland,Alan B. Storrow,William T. Abraham,Alan H.B. Wu,Paul Clopton,Philippe Gabriel Steg,Arne Westheim,Catherine W. Knudsen,Alberto Perez,Radmila Kazanegra,Howard C. Herrmann,Peter A. McCullough +17 more
TL;DR: Used in conjunction with other clinical information, rapid measurement of B-type natriuretic peptide is useful in establishing or excluding the diagnosis of congestive heart failure in patients with acute dyspnea.
Journal ArticleDOI
2013 ACCF/AHA Guideline for the Management of Heart Failure: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Clyde W. Yancy,Mariell Jessup,Biykem Bozkurt,Javed Butler,Donald E. Casey,Mark H. Drazner,Gregg C. Fonarow,Stephen A. Geraci,Tamara B. Horwich,James L. Januzzi,Maryl R. Johnson,Edward K. Kasper,Wayne C. Levy,Frederick A. Masoudi,Patrick E. McBride,John J.V. McMurray,Judith E. Mitchell,Pamela N. Peterson,Barbara Riegel,Flora Sam,Lynne W. Stevenson,W.H. Wilson Tang,Emily J. Tsai,Bruce L. Wilkoff +23 more
TL;DR: The medical profession should play a central role in evaluating the evidence related to drugs, according to a report by the World Health Organization and the European Medicines Agency.
References
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Journal ArticleDOI
Medical Therapy of Acute Myocardial Infarction by Application of Hemodynamic Subsets
TL;DR: The goals of prompt and effective therapy of disordered cardiac function and preservation of ischemic muscle, although far from achieved, have been greatly advanced in the past several years by the widespread use of hemodynamic monitoring.
Journal ArticleDOI
Pulmonary edema in dogs, especially the sequence of fluid accumulation in lungs.
Journal ArticleDOI
Vasodilator therapy of cardiac failure: (first of two parts).
Jay N. Cohn,Joseph A. Franciosa +1 more
TL;DR: The symptoms of cardiac failure are related to some combination of circulatory congestion and low cardiac output and therapy for cardiac failure has traditionally involved the Administration of an inotropic drug to increase the contractile force of the heart and the administration of a diuretic to increasing the renal excretion of salt and water.
Journal ArticleDOI
Increased exercise ventilation in patients with chronic heart failure: intact ventilatory control despite hemodynamic and pulmonary abnormalities.
TL;DR: The demonstration of a correlation between decreased cardiac output and increased ventilation in the patient group suggests that attenuated pulmonary perfusion may play a role in causing exercise hyperpnea in the presence of chronic heart failure by producing ventilation perfusion abnormalities and thereby increasing physiologic pulmonary dead space.
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