The conclusions of the review are partly obvious and partly distressing. What will be obvious to clinicians is that, in patients with known systolic dysfunction, few findings are needed to support a diagnosis of increased filling pressure, whereas in patients without a history of systolic dysfunction, at least 3 findings are needed to confirm this diagnosis. What is distressing about this systematic review is the low yield of many of the classic signs and symptoms and the vast overlap between normal and abnormal. However, caution must be used when interpreting studies that use pooled data. Although filling pressures are more reliable, in the studies reviewed here, the time between the clinical examination and the final diagnostic assessment varied.
Few experts approach a patient without first forming a hypothesis.
They intuitively calculate pretest probabilities and use many findings from the history, physical examination, and radiographic and electrographic studies to determine risk. The take-home message of this systematic review is that, although we need to train our clinicians better, even those with expert skills occasionally must rely on technology. Harold M. Szerlip, MD Tulane University School of Medicine New Orleans, Louisiana, USA Reference 1. Acad Emerg Med. All rights reserved.