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At the present time, syncope or heart failure (HF) is diagnosed by history or a syndrome composed of non-specific and non-pathognomonic physical findings. Even so, the above symptoms or findings are at the end of the disease process. There are many clinical confounders when the patients arrive to the emergency room with other concomitant conditions on top of HF such as chronic obstructive pulmonary disease (COPD) or cirrhosis of the liver or chronic kidney disease (CKD). There is a need for a specific test which can confirm the diagnosis of HF or cardiovascular dysfunction at the earliest time point and to guide the management of HF.
Patients with history of syncope, orthostatic hypotension or HF on top of COPD, chronic kidney disease (CKD), cirrhosis were enrolled. The patients in the control group received standard testing and treatment for HF. The study group underwent the new Expansibility of the Femoral Vein (EFV) and had treatment based on its results. The EFV is the ultrasound study of the femoral vein examining its size and expansibility during strong cough. In general, the location of the femoral artery and vein to be checked is the sagittal plane immediately proximal to the bifurcation of the superficial and deep femoral artery. The size of the femoral vein is a little larger than the size of the femoral artery. If the size of the femoral vein during cough is 3 times larger than the one at baseline, the test is considered normal. If the size of the femoral vein is >3 times larger than then baseline, it is considered abnormal suggesting excessive venous pooling. If the femoral vein expands only <2 times of the baseline during cough, it is considered abnormal suggesting present or future pulmonary hypertension. If this test was done in conjunction with a right heart catheterization, then the femoral vein pressure at baseline and during cough is recorded.
25 patients were enrolled from December 2015 to May 2016. The clinical diagnosis included syncope, persistent orthostatic hypotension, HF on top of cirrhosis of the liver or COPD. With the EFV test, the clinicians could re-correct the diagnoses in many patients or confirm the diagnosis of fluid overload in patients with severe non cardiac disease.
The patients with complex disease, the EFV could confirm early the presence of HF and guide its treatment amid of multiple complex confounders. Larger scale of clinical trial or registries of this new technique are needed.