Henry Ford Hospital Medical Journal


The clinical presentation of chronic heart failure has changed with advances in therapy, and the physical findings of congestion are now inconsistently present. To determine the clinical signs of congestion, we studied the clinical findings of 44 patients who had chronic heart failure and abnormal left ventricular ejection fractions (23 ± 10%). Signs of pulmonary edema manifested as rales were absent in all patients in New York Heart Association (NYHA) classes I and II, in 66% of patients in NYHA class III, and in 14% of patients in NYHA class IV. Signs of right heart failure manifested as elevated jugular venous pressure with or without peripheral edema were absent in 84% of NYHA class I and 66% of NYHA class III patients. This study indicates that a majority of patients in NYHA classes I through III can have impaired left ventricular performance without signs of congestion. The clinical diagnosis of heart failure can no longer depend on evidence of "congestion" since these signs are absent in many patients.



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