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Current diagnosis of heart failure (HF) is vague and impractical. There are conflicting opinions between clinicians in the diagnosis of HF on a same patient. The new classification is based on the condition of fluid in 3 compartments of the body. The intravascular part includes the intra-arterial and intravenous compartments. The extravascular compartment is mainly the fluid in the tissue (extracellular). Acute symptomatic HF with shortness of breath (SOB) happens when the capacitance of the intravascular compartment is overwhelmed. So we suggest a new test to confirm the status of fluid in the intravascular system mainly the venous system.
Patients were enrolled and physical examination was recorded for fluid overload in the venous system, mainly by the presence of rales in the lung and by painful sensation with a minimal punch in the right lower rib cage which means fluid overload in the liver (congested liver). Fluid overload in the extravascular system is defined as fluid infiltration in the abdominal wall, edema at the ankle, thigh, dependent areas. 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 at baseline is 3 times larger than the one at baseline, the test is considered positive and confirms that the patient is having severe fluid overload. 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 Group A: The patients were diagnosed based on traditional method. Group B: the patients were diagnosed with the new EFV test. Patient received diuretics which were titrated according the EFV results. All patients also had beta natriuretic peptide (BNP) level measured.
50 patients were enrolled from January 2015 to April 2016. All came with severe SOB. All the patients were diagnosed with dilated cardiomyopathy with low EF (mean EF= 36%). 30% patient had COPD, 34% had CKD, and 4% had cirrhosis of liver. 70% had clinical diagnosis of heart failure. With the EFV test, 95% of patients showed significant fluid overload in the intravascular compartment confirming the presence of acute on chronic systolic heart failure. This EFV test was better in confirming HF than BNP.
The EFV test was more accurate in confirming the diagnosis of acute decompensated HF than traditional diagnosis. The diagnosis was based on the significant fluid overload in the venous system as evidenced by the EFV test.