Clinical Diagnosis of Congestive Heart Failure in Patients with Acute Dyspnea: Discussion (Part 4)

Clinical Diagnosis of Congestive Heart Failure in Patients with Acute Dyspnea: Discussion (Part 4)There are several limitations of our study. The first, and most significant, is the lack of an incontrovertible “gold standard” or uniformly accepted criteria, for the diagnosis of congestive heart failure. It may be argued, for instance, that the “false-positive” Valsalva responses are actually “false-negatives” of the criteria used. However, the predetermined clinical criteria we elected to use were developed and validated against invasive hemodynamic measures by another research group, and we have also previously validated these criteria against radionuclide determination of LVEF. Further, since congestive heart failure is a clinical syndrome, we believe a clinical definition is appropriate, especially in light of the well-knowii limitations of such noninvasive “gold” standards as LVEF. Indeed, we have recently reported that the clinical diagnosis of congestive heart failure by these criteria is even a better predictor of survival than the LVEF. buy asthma inhalers
In this study, these criteria were modified by removing “wheezing.” This was done because we expected a high prevalence of patients with asthma and chronic obstructive pulmonary disease in this setting. Although wheezing is classically described as a component of congestive heart failure with pulmonary edema, some have argued that “cardiac asthma” is a misnomer, and does not truly exist (MH Williams, MD; oral communication, January 1989). Even if wheezing were important, it seems excessive to give the same number of points for the presence of wheezing as for an S3. Our data support removing wheezing from the criteria, as its inclusion would have classified 35 (69 percent) of our subjects as having definite congestive heart failure. Indeed, of 22 subjects with wheezing, 18 would have had definite congestive heart failure by the original criteria, compared with six based on our revised criteria.

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