Use of chest x-ray in diagnosing heart failure

7 August 2000

In an otherwise excellent commentary[1] (Can heart failure be diagnosed in primary care? ) on the article by Lyn Caruana and colleagues[2] , Prof. Richard Hobbs fails to mention the value of the chest X-ray. As every medical student knows the chest X-ray provides information on cardiac size and the major cardiac structures, and more fundamentally on any respiratory cause of breathlessness. It is even more extraordinary that in the article by Caruana et al, no mention of the chest X-ray in the diagnostic process is made in a study which was especially focussing on excluding other causes of the patients symptoms.

The current obsession with open-access echocardiography is tending to unnerve GP’s who feel that they cannot now make the diagnosis of heart failure without demonstrating abnormal left ventricular function. In fact the vast majority of patients can be diagnosed and treated with a knowledge of the past history, clinical findings, chest X-ray and ECG[3] .

Our own experience of open-access echocardiography over a two year period was that it added very little to the diagnostic process for those in primary care, except in the presence of a heart murmur[4] . Given the rising demands for specialist technician and medical time, it is neither realistic nor desirable to use echocardiography as a screening test for heart failure. BNP may prove better [3], but surely the first test in primary care for a breathless patient should be a chest X-ray.

Yours faithfully

Dr Chris Davidson
Sussex Cardiac Centre, Royal Sussex County Hospital Brighton BN2 5BE

1. Hobbs R, Can heart failure be diagnosed in primary care? BMJ 2000 321 188-9

2. Caruana L, Petrie MC, Davie AP, McMurray JJV. Do patients with suspected heart failure and preserved left ventricular function suffer from "diastolic heart failure" or from misdiagnosis? BMJ 2000 321 215-8

3. Landray MJ, Lehman R, Arnold I. Measuring brain naturetic peptide in suspected left ventricular systolic function in general practice. BMJ 2000 320 985-6

4. Wong PS, Doshi S, Open access echocardiography. Service is valuable for cardiac murmurs. BMJ 1995 311 326

Competing interests: None declared

Christopher Davidson, Cardiologist

Royal Sussex County Hospital, Brighton

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