Clinical Diagnosis of Congestive Heart Failure in Patients with Acute Dyspnea: Discussion (Part 6)

To evaluate this possibility, we examined the relation between the response to maneuvers and the presence of an S3 gallop. The S3 was chosen because it has the highest point count of any physical finding in this scale, as well as for its well-documented interobserver and intraobserver variability. In all, there were 12 patients with an S3. Of the six patients with hepatojugular reflux, four were also found to have had an S3; however, three of these subjects would have met criteria for congestive heart failure even without the presence of the S3. Of 17 subjects with a positive Valsalva response, seven had an S3; however, five would have met criteria anyway, and one did not meet criteria. Thus, even if observer bias influenced the auscultation of the S3, it had little if any impact on the findings in this study. flovent inhaler
Only about half of the eligible subjects were included in the study, mostly due to a language barrier or refusal to participate. However, available data suggest that the subjects included in this study were reasonably representative of the entire eligible population. Another limitation was the small sample size. The impact of a small sample in statistical analysis primarily affects an increased chance of a type II error, that is, failing to recognize a real difference. Since our study is not reporting a lack of association (ie, it is not a negative study), the small sample size was only a minor limitation.

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