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Make the Diagnosis: Heart Failure


Prior Probability


A broad range of prior probabilities (10%-40%) is required for clinical decisions, with outpatients who have suggestive symptoms at the lower end of the range and inpatients toward the upper end. The patient with dyspnea who presents to the emergency department without an obvious cause for dyspnea has about a 50% probability of left ventricular dysfunction (range, 34%-83%).


Population for Whom Left Ventricular Dysfunction Should Be Considered


  • Any patient with compatible symptoms, especially orthopnea and paroxysmal nocturnal dyspnea

  • Coronary artery disease, especially patients who have had a myocardial infarction

  • Hypertension

  • Diabetes mellitus

  • Patient receiving cardiotoxic medications

  • Family history of cardiomyopathy


Detecting the Likelihood of Left Ventricular Dysfunction


Patients with symptoms of heart failure and those with risk factors should be examined for pulmonary rales, jugular venous distention, a third heart sound, and peripheral edema and should have an ECG and chest radiograph (see Table 16-12).

Table Graphic Jump Location
Table 16-12Likelihood Ratios for Diagnosis of Left Ventricular Dysfunction

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