How useful are various exam findings in diagnosing congestive heart failure?

Bottom line:  Physical exam findings with highest positive likelihood ratios include presence of a third heart sound  (+LR =11, 4.9-25, and –LR =0.88, 0.83-0.94), abdominojugular reflux (+LR =6.4, 0.81-51, and –LR =0.79, 0.62-1.0) and jugular venous distention (+LR =5.1, 3.2-7.9, and –LR =0.66, 0.57-0.77).   Symptoms with highest positive likelihood ratios include presence of paroxysmal nocturnal dyspnea (+LR=2.6, 1.5-4.5, and –LR=0.70, 0.54-0.91) and orthopnea (+LR=2.2, 1.2-3.9, and –LR=0.65, 0.45-0.92).

Details:  Make the Diagnosis: Heart Failure.  In:  JAMAevidence.  Original Article: Does This Dyspneic Patient in the Emergency Department Have Congestive Heart Failure?  Wang CS, et al. 

Table 16-6 summarizes accuracy of findings from history and physical examination in this systematic review.

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About Amy

Clinical Informationist at EUH Branch Library
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