This review looks at the validity of clinical assessment and diagnostic tests in patients with suspected deep vein thrombosis. An algorithm is presented for the appropriate use of compression venous ultrasonography and venography in deciding when to anticoagulate patients. This excellent analysis does not utilize the d-dimer test which has good negative predictive value and is used by many to decrease the number of venograms that are performed. Due to the increasing prevalence of malignant melanoma it is important for primary care physicians to have a method for evaluating suspected skin lesions. Left-sided heart failure is characterized by a decreased left ventricular ejection fraction or increased filling pressure.
Systolic dysfunction occurs when the ejection fraction is decreased.
Diastolic dysfunction is persumed when the filling pressure is increased but the ejection fraction is normal and there is no other explanation. The best findings for detecting increased filling pressure are jugular venous distention and redistribution of pulmonary circulation on chest X-ray. For an analysis of the value of other findings please read the article. Absence of systolic murmur or murmur radiation to the right carotid reduces the likelihood of aortic stenosis. The absence of a mitral area late systolic or holosystolic murmur reduces the likelihood of mitral regurgitation with less reliability than the aortic stenosis findings.