title: Emergency diagnosis of congestive heart failure: impact of signs and symptoms.
abstract: BACKGROUND
  The most useful features in the diagnosis of congestive heart failure (CHF) have been poorly investigated.
  
  
  OBJECTIVE
  To determine the utility of signs and symptoms in the diagnosis of CHF in the emergency department.
  
  
  METHODS
  Detailed clinical data were collected prospectively from 452 consecutive patients presenting with acute dyspnea to the emergency department. By using logistic regression analysis, significant predictors for the final discharge diagnosis of CHF (adjudicated after review of all patient records, including response to therapy) were assessed.
  
  
  RESULTS
  In 217 of 452 patients (48%), CHF was the cause of acute dyspnea. Among symptoms, the OR for CHF was highest for weight gain (OR 3.6; 95% CI 1.9 to 7.0), nocturia (OR 2.4; 95% CI 1.6 to 3.7) and paroxysmal nocturnal dyspnea (OR 2.4; 95% CI 1.6 to 3.5), and lowest for fever (OR 0.36; 95% CI 0.22 to 0.56). Among signs, the OR was highest for elevated jugular venous pressure (OR 4.3; 95% CI 2.3 to 7.9), rales (OR 3.1; 95% CI 2.1 to 4.5), lower extremity edema (OR 2.8; 95% CI 1.9 to 4.3) and hepatojugular reflux (OR 2.7; 95% CI 1.4 to 5.2), and lowest for wheezing (OR 0.38; 95% CI 0.24 to 0.61). The overall sensitivity was low. The specificity was highest for elevated jugular venous pressure and hepatojugular reflux.
  
  
  CONCLUSIONS
  Signs and symptoms are only moderately helpful in the diagnosis of CHF in patients with acute dyspnea. This emphasizes the need for additional diagnostic tools, such as echocardiography or B-type natriuretic peptide testing.
authors.affiliation: University of Basel, University Hospital, Department of Internal Medicine, Basel, Switzerland. chmueller@uhbs.ch
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.forename: Barbara
authors.initials: B
authors.lastname: Frana
authors.forename: Daniel
authors.initials: D
authors.lastname: Rodriguez
authors.forename: Kirsten
authors.initials: K
authors.lastname: Laule-Kilian
authors.forename: André P
authors.initials: AP
authors.lastname: Perruchoud
mesh_terms: D000208:Acute Disease; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology* / Q000503:physiopathology; D004487:Edema; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007601:Jugular Veins / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010808:Physical Examination; D011446:Prospective Studies; D012135:Respiratory Sounds; D012680:Sensitivity and Specificity; D014555:Urination Disorders; D014690:Venous Pressure; D015430:Weight Gain