HOW TO EVALUATE A PATIENT WITH HEART-FAIL URE

Evaluation of heart failure is the first step prior to introduction of an adapted therapeutic strategy. Three principal objectives must be d efined: 1) identify the cause of heart failure, which may directly gui de subsequent treatment (valvular heart disease, coronary artery disea se, etc.); 2) evaluate the repercussions of heart failure on everyday life: evaluation of quality of life, severity of functional disorders and reduction of the everyday capacity. This evaluation is the most de licate as it is based on clinical interview: evaluation of the various NYHA stages lacks precision and reproductibility. The stress test wit h measurement of oxygen consumption appears to constitute an acceptabl e evaluation technique; 3) evaluation of the prognosis. Many studies h ave demonstrated precise relationships between life expectancy and a n umber of criteria, alteration of myocardial function, echocardiographi c findings, ejection fraction, cardiac output and even an AP chest x-r ay. Although statistically valid, these criteria have a limited applic ation in individual patients. Evaluation of all these parameters is th e most accurate way to predict the subsequent course of the disease wh ich therefore allows a more accurate choice of treatment and subsequen t evaluation of their efficacy.