Clinical Diagnosis of Congestive Heart Failure in Patients with Acute Dyspnea: Discussion (Part 1)

We found that the diagnosis of congestive heart failure is frequently missed in the emergency room assessment of the acutely dyspneic patient. Further, our data indicate that simple, bedside clinical maneuvers are valid in the assessment of acute shortness of breath in the emergency room and may be helpful in making the diagnosis of congestive heart failure.
The prevalence of congestive heart failure was twice as high based on predetermined criteria (45 percent) as on clinical diagnosis (24 percent). Including secondary diagnoses did not materially alter this relationship: only two patients had a secondary emergency room diagnosis of congestive heart failure, and the emergency room physician was still significantly less likely to diagnose congestive heart failure. This is especially noteworthy in light of the stringent diagnostic criteria used in this study: we included only those meeting the criteria for definite congestive heart failure, while 39 patients (76 percent) have definite or possible congestive heart failure, even using our modified criteria which exclude wheezing. buy ortho tri-cyclen

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