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  #1  
Old 02-05-2012
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Angry chf next step in dx? !!!!

A 71-year-old woman presents to an ambulatory
clinic with a chief complaint of dyspnea
upon exertion. Over the past few weeks she has
had a chronic cough and shortness of breath
when walking more than two city blocks. She
has a long history of hypertension that has been
poorly controlled in recent years. On physical
examination she has an elevated jugular venous
pulse and rales are evident on lung examination.
Cardiac enzyme tests are negative.
What is the most appropriate next step in distinguishing
systolic from diastolic heart failure?

(A) Cardiac catheterization
(B) Clinical judgment based on physical
examination
(C) CT scan of the chest
(D) Echocardiography
(E) Electrocardiogram
(F) MRI of the heart
(G) X-ray of the chest
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  #2  
Old 02-06-2012
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Star Echo

Echocardiography
you can confirm with this link-
http://eurheartj.oxfordjournals.org/...l_D/2.abstract
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Last edited by Aussie Guy; 02-06-2012 at 01:09 AM.
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Old 02-06-2012
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Star Echo

Vasan and Levy
15
proposed the diagnostic criteria for
“definite” diastolic HF. It requires definitive evidence of HF,
normal or mildly abnormal LVEF, and evidence of abnormal
LV relaxation, filling, diastolic distensibility, or diastolic
stiffness. The European criteria
16
are very similar to those of
Vasan and Levy, but appear to be more specific. The requirements are:
• signs or symptoms of congestive HF
• normal or mildly reduced LV systolic function and
normal chamber size
• abnormal LV relaxation, filling, and diastolic stiffness.
Vasan and Levy
15
recommend cardiac catheterization to
assess diastolic dysfunction, whereas the European recommendations
16
allow echocardiographic and Doppler studies
to document abnormalities in diastolic function. Obviously,
cardiac catheterization is invasive, expensive and, therefore,
impractical. But echocardiography is inexpensive and noninvasive, and therefore, very practical for clinical use.
You can check full article at -
http://www.cardiologyrounds.org/crus/cardious_1105.pdf
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  #4  
Old 02-06-2012
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Quote:
Originally Posted by Aussie Guy View Post
Vasan and Levy
15
proposed the diagnostic criteria for
“definite” diastolic HF. It requires definitive evidence of HF,
normal or mildly abnormal LVEF, and evidence of abnormal
LV relaxation, filling, diastolic distensibility, or diastolic
stiffness. The European criteria
16
are very similar to those of
Vasan and Levy, but appear to be more specific. The requirements are:
• signs or symptoms of congestive HF
• normal or mildly reduced LV systolic function and
normal chamber size
• abnormal LV relaxation, filling, and diastolic stiffness.
Vasan and Levy
15
recommend cardiac catheterization to
assess diastolic dysfunction, whereas the European recommendations
16
allow echocardiographic and Doppler studies
to document abnormalities in diastolic function. Obviously,
cardiac catheterization is invasive, expensive and, therefore,
impractical. But echocardiography is inexpensive and noninvasive, and therefore, very practical for clinical use.
You can check full article at -
http://www.cardiologyrounds.org/crus/cardious_1105.pdf
cant we distinguish it by clinical examination...that sounds okay as the next step..clinically, i mean if the heart size appears large[apex beat is shifted down and out] it implies systolic failure...whereas if the apex is not shifted...it is a diastolic failure...
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Old 02-07-2012
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Default

Quote:
Originally Posted by tyagee View Post
cant we distinguish it by clinical examination...that sounds okay as the next step..clinically, i mean if the heart size appears large[apex beat is shifted down and out] it implies systolic failure...whereas if the apex is not shifted...it is a diastolic failure...
It does sound okay as the next step, but would it direct your treatment? Echocardiograms are inexpensive (relatively, in the bloated economy of US medicine) and I think are considered standard of care. An echo would be the next step which would direct your treatment, whereas further physical examination would be mostly to satisfy our curiosity, or what we might do were an echo unavailable... I would choose echo for this question.
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  #6  
Old 02-07-2012
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Default Echo

It's echo ,,

No clinical exam can differentiate diastolic from systolic dysfunction

Mentioned in MTB
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  #7  
Old 02-07-2012
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Star

Quote:
Originally Posted by tyagee View Post
cant we distinguish it by clinical examination...that sounds okay as the next step..clinically, i mean if the heart size appears large[apex beat is shifted down and out] it implies systolic failure...whereas if the apex is not shifted...it is a diastolic failure...
Clinically we have to make sure that its a cardiac failure(Thats the criteria),but we cannot make sure with certainity what type of failure it is just by clinical exam.
Also they already have mentioned findings of JVD and Pulm.rales suggesting signs of failure;therefore Echo should be next.
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