Author + information
- Received October 27, 2017
- Revision received March 26, 2018
- Accepted April 3, 2018
- Published online June 6, 2018.
- Jennifer T. Thibodeau, MD, MSCS and
- Mark H. Drazner, MD, MSc∗ ()
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- ↵∗Address for correspondence:
Dr. Mark Drazner, Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9047.
Despite advances in biomarkers and technology, the clinical examination (i.e., a history and physical examination) remains central in the management of patients with heart failure. Specifically, the clinical examination allows noninvasive assessment of the patient’s underlying hemodynamic state, based on whether the patient has elevated ventricular filling pressures and/or an inadequate cardiac index. Such assessments provide important prognostic information and help guide therapeutic decision-making. Herein, we critically assess the utility of the clinical examination for these purposes and provide practical tips we have gleaned from our practice in the field of advanced heart failure. We note that the ability to assess for congestion is superior to that for inadequate perfusion. Furthermore, in current practice, elevated left ventricular filling pressures are inferred by findings related to an elevated right atrial pressure. We discuss an emerging classification system from the clinical examination that categorizes patients based on whether elevation of ventricular filling pressures occurs on the right side, left side, or both sides.
Dr. Drazner acknowledges research support from the James M. Wooten Chair in Cardiology. Dr. Thibodeau has reported that she has no relationships relevant to the contents of this paper to disclose.
- Received October 27, 2017.
- Revision received March 26, 2018.
- Accepted April 3, 2018.
- 2018 American College of Cardiology Foundation
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