DIASTOLIC HEART FAILURE: ARE THERE SPECIFIC BEDSIDE CLINICAL MARKERS FOR ITS DIAGNOSIS?

Background: Congestive heart failure due to diastolic dysfunction is common and accounts for 30-40 % of patients with congestive heart failure. Since the prognosis and clinical management of congestive heart failure differs between systolic and diastolic heart failure there is need to differentiate between the two. Echocardiography has been the only available tool for the diagnosis of diastolic heart failure in our area of clinical practice. In view of the high cost of echocardiographic examination and its non-availability in most medical centres, this study was undertaken to find out if bedside clinical markers could serve as an alternative way of making the diagnosis of diastolic heart failure. Methods: Left ventricular functions of 91 consecutive patients with congestive heart failure were determined by echocardiography with a view to separate these patients into those with isolated diastolic heart failure and those with isolated systolic heart failure. The frequency of each of the presenting signs and symptoms in both types of heart failure were recorded. The chest radiograph of each patient was done. Results: No singular sign or symptom could be ascribed exclusively to systolic or diastolic heart failure. Exertional dyspnoea had a hundred percent occurrence in both forms of heart failure. In 4 of the major Framingham criteria for the diagnosis of definite heart failure, the frequency of occurrence was different (but not statistically significant) in the two forms of heart failure. The frequency of cough, ankle oedema and tachycardia, which are minor criteria, showed statistically significant difference in both forms of heart failure. Conclusion: It is concluded from this study that there are no specific bedside clinical markers for the diagnosis of diastolic heart failure.