Correlation between Clinical and Echocardiographic Findings
Prior to echocardiography, dyspnea was attributed, clinically, to cardiac dysfunction in 66 patients (27 [41 percent] of w hom were randomized to receive echocardiography), to pulmonary causes in 97 patients (59 [61 percent] of w hom received echocardiograms), and to both cardiac and pulmonary causes in 31 patients (18 [58 percent] of w hom received echo studies). Two patients were not believed to have either a cardiac or a pulmonary basis for dyspnea; neither was randomized to receive an echocardiogram.
Echocardiography independently confirmed the clinical diagnosis in 72 percent of echo-randomized patients. However, in two (12 percent) of 18 echo-randomized patients who were clinically believed to have dyspnea from both cardiac and pulmonary causes, echo could not substantiate the presence of any left ventricular dysfunction, despite the conflicting clinical impression. Furthermore, echocardiography identified the presence of significant left ventricular dysfunction or aortic valvular disease in ten (17 percent) of 59 patients randomized to echo who were presumed, clinically, to have solely a pulmonary basis for dyspnea. ventolin inhalers
In such instances where echocardiographic and clinical diagnoses disagreed, the final clinical diagnosis rarely differed from the initial one, regardless of echo findings. For example, the initial clinical diagnosis of congestive heart failure and chronic obstructive pulmonary disease changed to a diagnosis of strictly pulmonary disease in only one of the two patients in whom echocardiography failed to detect any abnormality in left ventricular function. Conversely, the failure to initially recognize a cardiac basis for dyspnea was corrected in only one (10 percent) of the ten patients in whom echocardiography supported the presence of significant cardiac dysfunction.