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European Heart Journal 1989 10(11):1017-1028;
Copyright © 1989 by the European Society of Cardiology.
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© 1989 The European Society of Cardiology

Symptoms and signs of heart failure in patients with myocardial infarction: Reproducibility and relationship to chest X-ray, radionuclide ventriculography and right heart catheterization

N. GADSBØLL, P. F. HøILUND-CARLSEN, G. G. NIELSEN*, J. BERNING, N. E. BRUNN, P. STAGE{dagger}, E. HEIN, J. MARVING, H. LØNGBORG-JENSEN and B. H. JENSEN

Department of Cardiology C40, Department of Clinical Physiology and Nuclear Medicine and Department of Radiology, Glostrup Hospital, University of Copenhagen
*Statistical Research Unit, University of Copenhagen
{dagger}Department of Radiology, Hvidovre Hospital, University of Copenhagen Denmark

Received 19 January 1989; revised 19 April 1989; .

Address for correspondence: Niels Gadsbøll MD, Department of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, 2600 Glostrup, Denmark

Abstract

102 patients with myocardial infarction (MI) were examined by three clinicians, who independently recorded the following symptoms and signs: dyspnoea, a displaced apex beat, S3-gallop, rales, neck vein distension, hepatomegaly, and dependent oedema. Chest X-ray, radionuclide ventriculography, and (in 40 patients) right heart catheterization were carried out immediately after the physical examination. The clinicians frequently disagreed as to the presence of physical signs of heart failure in individuals. Moreover, these signs were of limited value in identifying patients with pulmonary vascular congestion on chest X-ray, reduced left or right radionuclide ventricular ejection fractions, enlarged ventricular volumes or haemodynamic evidence of ventricular dysfunction. We conclude that clinicians frequently disagree in the recognition of physical signs of heart failure, and that these signs have an unpredictable relationship to radiographic, radionuclide and haemodynamic measures of ventricular performance in patients with MI. Nevertheless, physical signs are useful in identifying patients with high risk of cardiac death.

Key Words: Myocardial infarction • heart failure • clinical examination • chest X-ray • radionuclide ventriculography


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