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.