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[Skill Modules
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Heart Sounds & Murmurs
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Evidence Base
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Evidence Base: Heart Sounds & Murmurs
Accuracy in Diagnosis of CHF
Question: Does this patient have congestive heart failure?
This study prospectively evaluated physical examination findings in 52 patients with underlying chronic left ventricular dysfunction and compared those results to hemodynamic measurements on heart catheterization.
Examination
Definition: elevated capillary wedge pressure >18 mmHg
Reference Butman et al.
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Clinical Findings for Detection of Heart Failure
Data from one study comparing the sensitivity and specificity of jugular venous distention with other studies are shown:
| Clinical Findings for Detection of Heart Failure |
Sensitivity Range |
Specificity Range |
| Increased filling pressure |
| Radiographic redistribution |
10% to 58% |
79% to 100% |
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| Jugular venous distention |
55% to 65% |
74% to 80% |
| Ejection fraction <40% |
| Radiographic cardiomegaly or redistribution |
4% to 33% |
87% to 100% |
| Anterior q-waves |
32% to 44% |
89% |
| Left-bundle branch block |
18% |
95% |
| Abnormal apical impulse |
31% to 36% |
89% to 95% |
| Diastolic dysfunction |
| Current hypertension |
60% to 61% |
59% to 70% |
*Adapted from Badgett, et al.
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