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• W1970047717 abstract "In an interesting prospective study of patients with clinical heart failure, Thomas and colleagues determined that there are no clear clinical parameters at the time of admission that can predict normal versus decreased systolic left ventricular function (1Thomas J.T. Kelly R.F. Thomas S.J. et al.Utility of history, physical examination, electrocardiogram, and chest radiograph for differentiating normal from decreased systolic dysfunction in patients with heart failure.Am J Med. 2002; 112: 437-445Abstract Full Text Full Text PDF PubMed Scopus (116) Google Scholar). In particular, they found that other than heart rate and, possibly, blood pressure, there are no physical examination findings that are more common in either subset of patients with heart failure, including S3 or S4 gallops. It should be noted that no prior clinical study, including this one, has researched the role of the point of maximal impulse (PMI) in this setting. The normal PMI is located in the fifth intercostal space at the midclavicular line (2Sapira J.D. The Art and Science of Bedside Diagnosis. Williams and Wilkins, Baltimore1990: 283Google Scholar). In patients with decreased systolic function, the PMI is often laterally displaced, diffuse, and sustained. Alternatively, in patients with normal systolic function or diastolic dysfunction, the PMI is not displaced and may be hyperdynamic (3Braunwald E. Zipes D.P. Libby P. Heart Disease A Textbook of Cardiovascular Medicine. W.B. Saunders, Philadelphia1997: 24-28Google Scholar). Clearly, this simple examination finding, if present, could help differentiate the two types of heart failure. The PMI is unlikely to be unitarily diagnostic, but it could be an important piece of information in Dr. Cheitlin’s “Boolean algebraic summation,” which leads to a diagnosis of heart failure, whether systolic or diastolic (4Cheitlin M.D. Can clinical evaluation differentiate diastolic from systolic heart failure? If so, is it important?.Am J Med. 2002; 112: 496-497Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar). Thus, the PMI should be performed as a routine part of every physical examination, but it may be particularly important in patients presenting with heart failure." @default.
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• W1970047717 date "2002-12-01" @default.
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• W1970047717 title "Point of maximal impulse and heart failure" @default.
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• W1970047717 doi "https://doi.org/10.1016/s0002-9343(02)01385-2" @default.
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