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Editorials |

Diagnosing Heart Failure by the Valsalva Maneuver : Isn’t It Finally Time?

Michael J. Zema, MD, FCCP
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Affiliations: Patchogue, NY 
 ,  Dr. Zema is Clinical Associate Professor of Medicine, State University of New York, and Chief, Division of Cardiology, Brookhaven Memorial Hospital Medical Center.

Correspondence to: Michael J. Zema, MD, FCCP, Chief, Division of Cardiology, Brookhaven Memorial Hospital Medical Center, 101 Hospital Rd, Patchogue, NY 11772



Chest. 1999;116(4):851-853. doi:10.1378/chest.116.4.851
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For decades, clinicians have diagnosed and treated the symptoms of left heart failure in their patients based on a carefully taken history, bedside physical examination, and chest radiograph. Symptoms such as orthopnea, paroxysmal nocturnal dyspnea, and dyspnea on exertion lack specificity, however, and may be seen in patients with chronic sinusitis as well as obstructive airways disease.12 The well-known physical findings of ventricular gallop sound, pulmonary rales, hepatojugular reflux, jugular venous distention, and peripheral edema, on the other hand, while reasonably specific in certain clinical settings, are unacceptably insensitive, making their absence in an individual patient of little value in excluding significant left ventricular dysfunction.35 Although it is far superior to the standard physical diagnostic signs, an upright chest radiograph that assesses the distribution of pulmonary blood flow and the presence or absence of radiographic cardiomegaly still has rather limited sensitivity, particularly for the detection of mild or moderate left ventricular dysfunction.24

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