INVESTIGATING HEART-FAILURE IN ELDERLY PEOPLE - DOES EVERYONE NEED ANECHOCARDIOGRAM

Objective: to establish whether an echocardiogram is always necessary when investigating heart failure (HF) in elderly patients. Method: a c linical assessment was compared with echocardiography in 51 elderly pa tients aged greater than or equal to 75 years complaining of breathles sness of more than 1 month's duration. Results: the greater the number of clinical features of HF present, the more likely was echocardiogra phy to reveal a potential cause. It revealed a potential cause of HF i n all 16 patients with strong clinical evidence (four or more features present). Of the 20 patients in whom clinical evidence of HF was equi vocal (two or three features present), the echocardiogram revealed a p otential cause of HF in nine and so was valuable in directing the diag nosis towards or away from HE In only two of the 15 patients with mini mal clinical evidence of HF (one feature or less) did the echocardiogr am reveal a potential cause of HE Severe valvular lesions were common, occurring in 20 (39%) patients. These were difficult to identify clin ically as clinical features were non-specific and murmurs were not alw ays present. Conclusions: echocardiography is most useful in those eld erly patients in whom the clinical diagnosis of HF is uncertain or for whom valvular surgery might be considered.