Thus, similar to some history and physical parameters, US has a high specificity and can confirm the presence of HF, but its low sensitivity precludes the ability to rule out its presence. In addition any combination of 2 of the modalities had a specificity of 93% or greater. The combination of all three modalities resulted in a poor sensitivity (36%), but an excellent specificity (100% 95% confidence interval, 95 to 100). This study evaluated the combination of cardiac US for left ventricular EF, inferior vena cava collapsibility and pulmonary interstitial edema (i.e., B lines) to establish a HF diagnosis. looked at the utility of bedside US in the diagnosis of HF using 3 modalities. īedside ultrasound (US) is an emerging study in the evaluation of potential HF patients. Table 1 summarizes the sensitivity and specificity for HF of these and other findings in patients presenting to the ED with dyspnea. It is notable that the majority of HF signs and symptoms have low sensitivity overall but perform better with regards to specificity and thus are better tests for ruling in a HF diagnosis as opposed to ruling it out. Although the sensitivity is low at 13%, its specificity of 99% should confirm a suspected diagnosis of HF in the dyspneic patient, albeit it may be difficult to auscultate in a busy and noisy ED. The S3 remains one of the best clinical indicators for HF. Crackles on lung exam have a sensitivity of 60% and specificity of 78% while jugular venous distention has a sensitivity and specificity of 39% and 92%. Edema has a sensitivity and specificity of 50% and 78%. Typical findings associated with acute decompensated heart failure (ADHF) include jugular venous distention or distended neck veins, peripheral edema, pulmonary crackles, and an S3 on heart examination.
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