Essentials of the diagnosis of heart failure

Although heart failure is a common clinical syndrome, especially in the eld erly, its diagnosis is often missed. A detailed clinical history is crucial and should address not only current signs and symptoms of heart failure bu t also signs and symptoms that point to a specific cause of the syndrome, s uch as coronary artery disease, hypertension or valvular heart disease. It is important to determine whether the patient has had a previous cardiac ev ent, in particular a myocardial infarction. The physical examination should include Valsalva's maneuver, a test that is highly specific and sensitive for the detection of left ventricular systolic and diastolic dysfunction in patients with heart failure. An electrocardiograph and a chest radiograph should also be obtained. Two-dimensional echocardiography of the heart help s differentiate systolic from diastolic dysfunction. Coronary angiography i s indicated in patients with heart failure and anginal chest pain and shoul d be strongly considered in patients with an electrocardiogram suggestive o f ischemia or myocardial infarction.