המידע מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – Elevated jugular venous pressure and a third heart sound predict poor outcomes in patients with heart failure, according to a report published in the August 23rd issue of The New England Journal of Medicine.
Dr. Mark H. Drazner, from the University of Texas Southwestern Medical Center at Dallas, and colleagues assessed the prognostic significance of elevated jugular venous pressure and/or a third heart sound in 2569 patients with current or past symptomatic heart failure.
Multivariate analysis adjusted for other markers of heart failure severity revealed that patients with one or both of the physical exam findings were significantly more likely to be hospitalized for heart failure than patients without these findings, the authors state. These patients were also at increased risk for death from all causes and for death from pump failure, although not death from arrhythmia.
"There have been a number of reports in the literature suggesting that physicians-in-training are becoming less proficient in their physical examination skills," Dr. Drazner told Reuters Health. "Part of the reason may be that physicians are more interested in new diagnostic technologies, but part of it might also be that there is a lack of data showing that the physical examination is important," he explained.
"In the current study, we found that the presence of elevated jugular venous pressure and/or a third heart sound predicted worse outcomes," Dr. Drazner said. "We think these findings may provide impetus for performing a skilled physical examination," he noted. "In the medical school setting, a senior physician could teach medical students how to look for both of these findings."
In an editorial, Dr. Joseph K. Perloff, from the University of California at Los Angeles, comments that "it is exciting that late 19th- and early 20th-century interest in the jugular venous pulse and the third heart sound is reflected in the evidence-based, statistically analyzed investigation reported by" Dr. Drazner's team.
"Studies such as that reported by Drazner et al. underscore the importance, even in contemporary medical practice, of performing a skillful physical examination," Dr. Perloff concludes.
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