The limited reliability of physical signs for estimating hemodynamics in chronic heart failure
Article Abstract:
In chronic heart failure, the ability of the heart to pump blood is diminished, so that it provides a blood flow which does not meet the demands of the body. Patients with this condition need constant surveillance by their doctors. The reliability of using simple measurements to assess these patients was evaluated. Heart failure is associated with an abnormal third heart sound, lung noises (rales), abnormal jugular vein pulses, and the collection of tissue fluid in the subcutaneous tissues of the body (edema). Fifty patients who were known to have heart failure underwent various anatomical and physiological measurements of their hearts and blood-vessel systems, and the results were correlated to the findings of physical examinations. Although several of these signs (i.e., third sound, rales, jugular pulses and edema), when seen together were completely reliable indicators of the disease (100 percent specificity), they were only detected in approximately half of the patients (sensitivity of 58). Of these simple measurements, only pulse pressure (systolic pressure minus diastolic pressure; e.g. 120 over 80 = 40 pulse pressure) was a reliable index of the cardiac output (the amount of blood pumped by each side of the heart in one minute). These results indicate that more sophisticated testing is required to follow adequately the course of a patient with heart failure.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1989
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Can the clinical examination diagnose left-sided heart failure in adults?
Article Abstract:
Failure of the left ventricle of the heart can be a diagnostic challenge. The physician must also distinguish between a failure of the heart's pumping capacity (systolic failure) and a failure of its filling capacity (diastolic failure) since the treatments would differ. Researchers analyzed 34 studies that assessed the effectiveness of clinical signs in the diagnosis of left-sided heart failure. An enlarged heart on X-ray, an abnormal apical impulse and q waves on a ECG are reliable signs of systolic failure. Jugular venous distention and blood redistribution on X-ray are reliable signs of diastolic failure.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1997
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Evaluation of vaginal complaints
Article Abstract:
The role of clinical examination in the diagnosis of vaginal complaints is evaluated. The positive and negative likelihood ratios (LRs) for the diagnosis of vaginal candidiasis, bacterial vaginosis and vaginal trichomoniasis are examined.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 2004
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