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Fluids & Electrolytes
THURSDAY, Sept. 18 (HealthDay News) -- Estimates of hemodynamic parameters from a history and physical exam are largely accurate and can predict death or rehospitalization in patients with advanced heart failure, according to study findings published in the September issue of Circulation: Heart Failure.
Mark H. Drazner, M.D., from the University of Texas Southwestern Medical Center in Dallas, and colleagues examined six-month outcomes in 388 patients with advanced heart failure whose filling pressures and cardiac index were determined by a history and physical exam. Half of these patients also had the same measurements made by right heart catheterization.
The researchers found that the history and physical measurement (estimated from jugular veins) agreed with the catheterization measurement in 82 percent of patients when the right arterial pressure was less than 8 mm Hg and in 70 percent of patients when the pressure was greater than 12 mm Hg. History and physical estimates of right arterial pressure of 12 mm Hg or more and orthopnea of 2 pillows or more were significantly associated with pulmonary capillary wedge pressures of 30 mm Hg or more. Although the estimated and measured cardiac indices did not match, a "cold" or "warm" profile of the extremities (indicating poor or good perfusion) at discharge predicted death or rehospitalization, the authors note.
"The history and physical examination allowed accurate estimation of the right arterial pressure and reasonable discrimination as to whether left-sided filling pressures were increased or not, principally based on estimation of the jugular venous pressure or presence of orthopnea," Drazner and colleagues conclude. "These data provide a basis of evidence for the use of the history and physical examination in the evaluation and management of heart failure and should spur renewed emphasis on learning and teaching the increasingly neglected history and physical examination."
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