Atypical features make echocardiography mandatory in suspected heart failure

doi:10.1136/bmj.328.7445.945

BMJ 2004;328:945 (17 April), doi:10.1136/bmj.328.7445.945

Commentary

Atypical features make echocardiography mandatory in suspected heart failure

Allan D Struthers, professor of cardiovascular medicine and therapeutics¹

¹ Ninewells Hospital, Dundee DD1 9SY a.d.struthers@dundee.ac.uk

The first 150 words of the full text of this article appear below.

One of the key skills of a good diagnostician is to spot whena patient's case has enough atypical features for there to bea strong chance that the "obvious" diagnosis might be wrong.This suspicion would lead a good diagnostician to perform extrainvestigations.

In this case, the normal electrocardiographic appearance virtuallyexcluded the possibility of left ventricular systolic dysfunction(figure). The other less reliable atypical features were thelack of any history of ischaemic heart disease and the lackof any response to furosemide (although the dose might not havebeen high enough). Of course, these alerting, atypical featureshad to be balanced against all the positive features suggestingheart failure: hypertension, pansystolic murmur, raised jugularvenous pressure, pleural effusions, and possible cardiomegaly.

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Patient's initial 12 lead electrocardiogram

It was somewhat unusual that an angiotensin converting enzymeinhibitor was given before the result of echocardiography was. . . [Full text of this article]

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