ABC of heart failure - Clinical features and complications
- By: C R Gibbs, M K Davies, G Y H Lip
Patients with heart failure present with a variety of symptoms, most of which are non.specific. The common symptoms of congestive heart failure include fatigue, dyspnoea, swollen ankles, and exercise intolerance, or symptoms that relate to the underlying cause. The accuracy of diagnosis by presenting clinical features alone, however, is often inadequate, particularly in women and elderly or obese patients.
Oedema and a tachycardia, for example, are too insensitive to have any useful predictive value, and although pulmonary crepitations may have a high diagnostic specificity they have a low sensitivity and predictive value. Indeed, the commonest cause of lower limb oedema in elderly people is immobility, and pulmonary crepitations may reflect poor ventilation with infection, or pulmonary fibrosis, rather than heart failure. Jugular venous distension has a high specificity in diagnosing heart failure in patients who are known to have cardiac disease, although some patients, even with documented heart failure, do