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

For inclusion in this study, patients had to meet the following criteria: the chief complaint of shortness of breath; age ^40 years; English speaking; entered the emergency room during study hours; and gave informed consent to participate. Buy Asthma Inhalers Online
Once patients agreed to participate in this investigation, a standardized history was obtained by a research assistant. A physical examination was then performed by a single physician (PR\1) blinded to the history and to the treatment of the emergency room staff. The hepatojugular reflux and Valsalva maneuvers were performed in a standardized fashion, as previously described.  The hepatojugular reflux maneuver was performed with the patient at approximately 45 degrees. A pressure of 35 mm Hg was maintained over the alxlomen l>y use of a partially inflated blood pressure cuff. Pressure was maintained over 10 seconds, and an increase of at least 3 cm H20 was called a positive response.
The Valsalva maneuver was performed with the blood pressure cuff inflated to 15 mm Hg over the systolic blood pressure, and auscultation carried out in the antecubital fossa. An interpretable Valsalva response required at least two beats heard during the initiation of the maneuver.

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