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Dyspnea and Heart Failure in the Emergency Department
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To the Editor: In The Rational Clinical Examination article addressing dyspnea and heart failure in the emergency department, Dr Wang and colleagues1 cite a single prospective study of 51 patients presenting to an emergency department with dyspnea, in which the blood pressure response to the Valsalva maneuver was recorded and compared with the left ventricular ejection fraction estimated by transthoracic echocardiography.2 The 95% confidence intervals of both the positive and negative likelihood ratios in this study contained 1.0, which prompted Wang et al to state that this examination finding "did not appear useful for assessing the likelihood of heart failure in dyspneic patients."
However, this ignores other studies that demonstrate that the presence and magnitude of abnormal blood pressure response to the Valsalva maneuver is useful for not only diagnosing the degree of systolic heart failure (ie, predicting left ventricular ejection fraction),3-4 but also discriminating between dyspnea due to systolic . . . [Full Text of this Article]
Amnon Schlegel, MD, PhD
aschlege@itsa.ucsf.edu
Department of Medicine
University of California, San Francisco
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