Establishing a diagnosis in patient...

Establishing a diagnosis in patients who existing with acute dyspnea can be a challenge. individual possible cause is acute heart failure. If the diagnosis of acute heart failure can be quickly established, willing medical therapy can be provided. Chest radiography is single in kind tool used to identify patients with acute heart failure. This example is inexpensive and can identify heart failure and left ventricular dysfunction. Another tool freshly developed is determination of B-type natriuretic peptide (BNP) plain BNP levels are increased in patients with increased ventricular bulk and pressure overload. This criterion has been shown to accurately identify patients with heart failure. There are no popular studies examining the combination of chest radiography and BNP in the diagnosis of heart failure in patients with acute dyspnea. Knudsen and associates assessed the accuracy of cardiomegaly and redistribution forward the chest radiography and different BNP flats for the diagnosis of heart failure in patients with acute dyspnea.

The contemplation was a multicentered examination of patients who existinged to the emergency department with acute dyspnea. Patients with obvious causes for acute dyspnea, like as injuries or pneumothorax, were exclud Basic demographic characteristics, clinical history, and clinical signs were recorded. An electrocardiogram (ECG) and chest radiographs were obtained. During the initial evaluation, progeny was drawn, and BNP of the same heights were analyzed by a rapid point-of-care device. After the initial assessment, the information was reviewed by means of two independent cardiologists who used an established observe score to identify patients with acute heart failure.

A total of 447 patients were diagnosed with acute heart failure, and 433 had acute dyspnea resulting from other causes. BNP horizontals were significantly higher in the heart failure cluster and 90 percent had flats of 100 pg per mL or higher. Chest radiography findings of cardiomegaly had a sensitivity of 79 percent and a specificity of 80 percent for diagnosis of acute heart failure. Radiographic findings of cephalization, interstitial edema, and alveolar edema were all highly specific however insensitive markers for acute heart failure. Adding a BNP flush of 100 pg per mL or more and radiographic findings of cardiomegaly, cephalization, and interstitial edema to the historical and clinical predictors of heart failure significantly improved the predictive values of these variables.

The authors terminate that in patients with acute dyspnea, BNP evens and chest radiography provide complementary diagnostic information. These sum of two units tests, combined with a detailed history, thorough physical examination, and ECG can help physicians differentiate acute heart failure and other causes of acute dyspnea.

KARL E MILLER, MD Knudson CW et al. Diagnostic value of B-type natriuretic peptide and chest radiographic findings in patients with acute dyspnea. Am J M March 15 2004;116:363-8

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group