Thursday, January 26, 2006

Normal Chest X-ray in Heart Failure

Chest Radiographs Negative for One in Five Acute Heart Failure Patients
"Nearly one in five patients admitted to an emergency department with decompensated heart failure will have negative chest radiography results, a new analysis of registry data suggests.
The findings are consistent with past research suggesting that the test will find no signs of congestion in a substantial proportion of acute heart failure patients. The chest X-ray is still really an invaluable tool in the emergency physician's workup of heart failure But physicians who suspect heart failure in a patient should not conclude it isn't there if a chest radiograph is negative
."

Reference- Ann Emerg Med 2006;47:13-21.

Source- Reuters Health Information

1 comment:

Tony Joseph, MD, FACEP said...

Heart Failure (HF) is increasing in both incidence and prevalence in the United States. Nearly 100% of those with HF will require hospitalization at some time during their illness for acute decompensation. The chest x-ray (CXR) done in the emergency department (ED) can give important insight into the disease process and where the patient is on the disease continuum.

This article correctly cautions the ED physician to “look at the patient.” The CXR can possibly be normal in appearance even in the face of ADHF. We must recall that in acute heart attack (even STEMI) that it is relatively common to see normal ECGs in patients with active heart attack. We should not be surprised to find this phenomenon in other disease states.

The CXR must always be used n the proper clinical context along with other factors such as symptoms of HF, signs of HF, 12 lead ECG, cardiac Troponin, and BNP.

The Healthcare Accreditation Colloquium has launched a major process improvement initiative in heart failure which includes an emergency department risk stratification approach to the early diagnosis and treatment of heart failure in the emergency department.

Check it out => http://www.thacinc.com/

Tony Joseph, MD, FACEP

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