[Symptoms and natural history of cardiovascular diseases: obsolete?].
The role of symptoms in establishing a diagnosis in cardiovascular diseases has decreased. Treatment privileges action and underestimates the potentially favourable spontaneous outcome of the treated condition. The object of this article is not to question the progress made in presymptomatic diagnosis of certain cardiovascular diseases or the benefits of treatment prescribed for some a- or paucisymptomatic patients: recent reports, particularly in asymptomatic aortic regurgitation, silent ischemia and subclinical left ventricular dysfunction of cardiomyopathy have confirmed the utility of therapy in these cases. However, the risks of misinterpreting a symptom and the natural history should be underlined: the "complaint" of the patient not properly assessed; cascades of "complementary investigations" of debatable utility and uncertain interpretation, when taken out of context; substitution of the medical therapeutic offer on demand of the patient and inadequate patient education concerning possible therapeutic approaches: the quest for intermediary objectives (anatomic, physiologic, biologic), which have not been shown to increase the quality or duration of life; the disproportion between the small number of validated therapies and the ever increasing range of interventional audacities in asymptomatic patients... It is important that general pathology and the natural history of cardiovascular diseases are taught again in France. With respect to symptoms, proper assessment no longer depends on "clinical judgment"; it should have a greater role in diagnosis of cardiovascular diseases by the understanding of the physiopathological mechanisms, Bayesian assessment of its predictive value, and accurate inclusion in multiparameter scores derived from recent large scale epidemiologic and therapeutic trials.
Delahaye
J P
JP
Hôpital cardiologique, BP Lyon-Montchat.
D002309:Cardiology / Q000193:education; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008487:Medical History Taking / Q000379:methods*
Le symptôme et l'histoire naturelle des maladies cardiovasculaires: obsolètes?