The Experts below are selected from a list of 6 Experts worldwide ranked by ideXlab platform
Steven Mcgee - One of the best experts on this subject based on the ideXlab platform.
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Physical examination of venous pressure: A critical review
American heart journal, 1998Co-Authors: Steven McgeeAbstract:Objective To explain why investigations of the measurement of central venous pressure (CVP) usually reveal a discrepancy between the clinician's estimate of CVP from physical diagnosis and supine measurement with a catheter. Data from MEDLINE search, personal files, and bibliographies of textbooks on physical diagnosis and cardiology were used. Results The most important reasons for this disagreement are the failure to standardize the external reference point used by the clinician to indicate "zero" venous pressure and the failure to recognize that venous pressure often depends on the position of the patient during examination. During physical examination clinicians tend to underestimate the CVP, as measured by a catheter in the same patient positioned supine, especially when the measured value is high. This occurs because the venous pressure of patients with heart failure, in contrast to that of healthy individuals, demonstrates an exaggerated postural fall when the patient is in the more upright positions that are necessary to visualize the elevated neck veins. The cause of this postural instability, increased venoconstriction from sympathetic tone, also helps explain two other physical findings of the jugular veins, the Abdominojugular Test, and Kussmaul's sign. Conclusions Clinicians should avoid making decisions about degrees of CVP elevation that are imprecise and difficult to reproduce. Instead, they should determine during physical diagnosis merely whether the CVP is elevated. Until further research is done, the best definition of elevated CVP is that of Sir Thomas Lewis-when the top of the external or internal jugular veins is >3 cm of vertical distance above the sternal angle, the CVP is abnormally high.
Elizabeth A. Hahn - One of the best experts on this subject based on the ideXlab platform.
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Bedside cardiovascular examination in patients with severe chronic heart failure: Importance of rest or inducible jugular venous distension
Journal of the American College of Cardiology, 1993Co-Authors: Samuel M. Butman, Gordon A. Ewy, James R. Standen, Karl B. Kern, Elizabeth A. HahnAbstract:Abstract Objective. The aim of this study was to determine the sensitivity, speciticty and utility of the cardiovascular examination in predicting cardiac hemodynamics in patients with advanced chronic congestive heart failure. Background. Although the physical signs of acute left heart failure have been shown to correlate relatively well with cardiac hemodynamics, their reliability in estimating hemodynamics in patients with chronic heart failure has recently been questioned. Methods. We prospectively recorded the history, cardiovascular physical signs present at bedside examination and the hemodynamic measurements obtained at right heart catheterization in 52 patients with chronic congestive heart failure undergoing in-hospital evaluation for possible heart transplantation. In addition, we obtained chest radiographs and multigated nuclear scans for the evaluation of left ventricular function. Results. Pulmonary rates, a left ventricular third heart sound, jugular venous distension and the Abdominojugular Test, when positive, indicated higher right heart pressures and lower measures of cardiac performance. The presence of jugular venous distension, at rest or inducible, had the best combination of sensitivity (81%), specificity (80%) and predictive accuracy (81%) for elevation of the pulmonary capillary wedge pressure (≥8 mm Hg). Furthermore, in this population sample, the probability of an elevated wedge pressure was 0.86 when either variable was present. Conclusions. The bedside cardiovascular examination in the patient with chronic heart failure is extremely useful in identifying patients with elevation of right and left heart pressures. Examination for jugular venous distension at rest or by the abdomino-jugular Test is simple and highly sensitive and specific in assessing left heart pressures in these patients.
Samuel M. Butman - One of the best experts on this subject based on the ideXlab platform.
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Bedside cardiovascular examination in patients with severe chronic heart failure: Importance of rest or inducible jugular venous distension
Journal of the American College of Cardiology, 1993Co-Authors: Samuel M. Butman, Gordon A. Ewy, James R. Standen, Karl B. Kern, Elizabeth A. HahnAbstract:Abstract Objective. The aim of this study was to determine the sensitivity, speciticty and utility of the cardiovascular examination in predicting cardiac hemodynamics in patients with advanced chronic congestive heart failure. Background. Although the physical signs of acute left heart failure have been shown to correlate relatively well with cardiac hemodynamics, their reliability in estimating hemodynamics in patients with chronic heart failure has recently been questioned. Methods. We prospectively recorded the history, cardiovascular physical signs present at bedside examination and the hemodynamic measurements obtained at right heart catheterization in 52 patients with chronic congestive heart failure undergoing in-hospital evaluation for possible heart transplantation. In addition, we obtained chest radiographs and multigated nuclear scans for the evaluation of left ventricular function. Results. Pulmonary rates, a left ventricular third heart sound, jugular venous distension and the Abdominojugular Test, when positive, indicated higher right heart pressures and lower measures of cardiac performance. The presence of jugular venous distension, at rest or inducible, had the best combination of sensitivity (81%), specificity (80%) and predictive accuracy (81%) for elevation of the pulmonary capillary wedge pressure (≥8 mm Hg). Furthermore, in this population sample, the probability of an elevated wedge pressure was 0.86 when either variable was present. Conclusions. The bedside cardiovascular examination in the patient with chronic heart failure is extremely useful in identifying patients with elevation of right and left heart pressures. Examination for jugular venous distension at rest or by the abdomino-jugular Test is simple and highly sensitive and specific in assessing left heart pressures in these patients.
Gordon A. Ewy - One of the best experts on this subject based on the ideXlab platform.
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Bedside cardiovascular examination in patients with severe chronic heart failure: Importance of rest or inducible jugular venous distension
Journal of the American College of Cardiology, 1993Co-Authors: Samuel M. Butman, Gordon A. Ewy, James R. Standen, Karl B. Kern, Elizabeth A. HahnAbstract:Abstract Objective. The aim of this study was to determine the sensitivity, speciticty and utility of the cardiovascular examination in predicting cardiac hemodynamics in patients with advanced chronic congestive heart failure. Background. Although the physical signs of acute left heart failure have been shown to correlate relatively well with cardiac hemodynamics, their reliability in estimating hemodynamics in patients with chronic heart failure has recently been questioned. Methods. We prospectively recorded the history, cardiovascular physical signs present at bedside examination and the hemodynamic measurements obtained at right heart catheterization in 52 patients with chronic congestive heart failure undergoing in-hospital evaluation for possible heart transplantation. In addition, we obtained chest radiographs and multigated nuclear scans for the evaluation of left ventricular function. Results. Pulmonary rates, a left ventricular third heart sound, jugular venous distension and the Abdominojugular Test, when positive, indicated higher right heart pressures and lower measures of cardiac performance. The presence of jugular venous distension, at rest or inducible, had the best combination of sensitivity (81%), specificity (80%) and predictive accuracy (81%) for elevation of the pulmonary capillary wedge pressure (≥8 mm Hg). Furthermore, in this population sample, the probability of an elevated wedge pressure was 0.86 when either variable was present. Conclusions. The bedside cardiovascular examination in the patient with chronic heart failure is extremely useful in identifying patients with elevation of right and left heart pressures. Examination for jugular venous distension at rest or by the abdomino-jugular Test is simple and highly sensitive and specific in assessing left heart pressures in these patients.
James R. Standen - One of the best experts on this subject based on the ideXlab platform.
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Bedside cardiovascular examination in patients with severe chronic heart failure: Importance of rest or inducible jugular venous distension
Journal of the American College of Cardiology, 1993Co-Authors: Samuel M. Butman, Gordon A. Ewy, James R. Standen, Karl B. Kern, Elizabeth A. HahnAbstract:Abstract Objective. The aim of this study was to determine the sensitivity, speciticty and utility of the cardiovascular examination in predicting cardiac hemodynamics in patients with advanced chronic congestive heart failure. Background. Although the physical signs of acute left heart failure have been shown to correlate relatively well with cardiac hemodynamics, their reliability in estimating hemodynamics in patients with chronic heart failure has recently been questioned. Methods. We prospectively recorded the history, cardiovascular physical signs present at bedside examination and the hemodynamic measurements obtained at right heart catheterization in 52 patients with chronic congestive heart failure undergoing in-hospital evaluation for possible heart transplantation. In addition, we obtained chest radiographs and multigated nuclear scans for the evaluation of left ventricular function. Results. Pulmonary rates, a left ventricular third heart sound, jugular venous distension and the Abdominojugular Test, when positive, indicated higher right heart pressures and lower measures of cardiac performance. The presence of jugular venous distension, at rest or inducible, had the best combination of sensitivity (81%), specificity (80%) and predictive accuracy (81%) for elevation of the pulmonary capillary wedge pressure (≥8 mm Hg). Furthermore, in this population sample, the probability of an elevated wedge pressure was 0.86 when either variable was present. Conclusions. The bedside cardiovascular examination in the patient with chronic heart failure is extremely useful in identifying patients with elevation of right and left heart pressures. Examination for jugular venous distension at rest or by the abdomino-jugular Test is simple and highly sensitive and specific in assessing left heart pressures in these patients.
