Physical examination findings are important in predicting outcomes in heart failure, researchers report

August 22, 2001

DALLAS - Aug. 23, 2001 - Two common findings from a traditional physical examination can provide important information for the 5 million Americans diagnosed with heart failure, according to researchers at UT Southwestern Medical Center at Dallas.

In a retrospective analysis of a large heart-failure trial, published in today's issue of The New England Journal of Medicine, researchers found that patients with either a third heart sound or elevated jugular venous pressure were more likely to have progressive heart failure and subsequent hospital visits due to heart failure.

The researchers from the heart failure research unit of the Donald W. Reynolds Cardiovascular Clinical Research Center analyzed results from physical examinations recorded in 2,569 heart-failure patients involved in the Studies of Left Ventricular Dysfunction (SOLVD) treatment trial. The researchers also found that the subgroup of patients with a third heart sound or elevated jugular venous pressure had a significantly higher risk of death.

Findings from this analysis will help physicians assess the severity of their patients' heart failure, said Dr. Mark Drazner, assistant professor of internal medicine and lead author of the study.

"The independent prognostic value of either a third heart sound or elevated jugular venous pressure has not been well-established until now," Drazner said. "Detection of these two findings on a physical examination identifies patients at increased risk for adverse events. This improved risk-stratification may allow physicians to improve treatment for patients with heart failure."

In healthy adults only two heart sounds are detected, which are often referred to as "lub-dub." A third heart sound, known as a "gallop," sometimes occurs after the two normal heart sounds.

"Whenever a physician listens to an adult patient's heart with a stethoscope, they should be listening for a third heart sound. This may provide an important clue that the heart is not functioning well," Drazner said.

Physicians assess jugular venous pressure by observing the pulsations in the jugular veins visible in the neck. "An elevation in the jugular venous pressure may reflect that a patient with heart failure has retained extra fluid," Drazner said.

Recently, there have been concerns that physicians' interest and skill in performing the physical examination are on the decline, which may be partly due to a new wave of high-tech imaging machines, Drazner said.

"Physicians are spending an increasing amount of time learning additional new technologies, which simply takes time away from mastering the physical examination. The message of this study is that the physical examination provides important information even in the present era of sophisticated technology," Drazner said.

Physicians should not become so reliant on new technologies that they lose focus on the role and importance of a standard physical examination, Drazner said. "A central purpose of this study is to highlight to physicians and physicians-in-training that the physical examination does provide important prognostic information. We feel that in an era of evidence-based medicine, scientific studies assessing the value of a physical examination are extremely important to provide impetus for continued interest in the physical examination."

Dr. Daniel Dries, assistant professor of internal medicine, and Dr. J. Eduardo Rame, a research fellow at UT Southwestern's Donald W. Reynolds Cardiovascular Clinical Research Center, were co-authors of the study.

UT Southwestern Medical Center

Related Heart Failure Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Machining the heart: New predictor for helping to beat chronic heart failure
Researchers from Kanazawa University have used machine learning to predict which classes of chronic heart failure patients are most likely to experience heart failure death, and which are most likely to develop an arrhythmic death or sudden cardiac death.

Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.

Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population

Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.

Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.

Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.

Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.

How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.

Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

Read More: Heart Failure News and Heart Failure Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to