Author + information
- Manish Mehta, MD and
- Sanjiv Kaul, MD∗ ()
- ↵∗Knight Cardiovascular Institute, Oregon Health & Science University, UHN 62, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239
We agree with Dr. Chatterjee that history is key to making a diagnosis. In our paper (1), we did not suggest a substitution of history by handheld ultrasound (HHU), but the substitution of the stethoscope. In regard to heart failure, again it is a clinical diagnosis, as Dr. Chatterjee rightly states, but HHU can differentiate patients with reduced left ventricular (LV) systolic function from those with “normal” LV function. It can also be used to measure the size of the inferior vena cava, thus helping in the estimation of right heart filling pressure. It can provide an assessment of right ventricular size and function, which are independently related to prognosis. Other findings that may be important in heart failure that can be picked up by HHU and may not be evident on physical examination are LV and left atrial size, wall thickening abnormalities indicating presence of coronary artery disease, presence and severity of mitral and tricuspid regurgitation, presence of LV thrombus, and visual assessment of LV dyssynchrony. All of these findings can assist in making management decisions.
To our knowledge, there are no data in regard to the value of repeated examinations with HHU in terms of managing patients. It may be that clinical examination alone may be adequate in most patients once a comprehensive initial assessment has been made. HHU may be useful when the clinical situation changes. More studies are needed to address this issue.
Finally, the days of the giants of physical examination such as Aubrey Leatham (2) and Proctor Harvey (3) are, unfortunately, over. And there are only a few Kanu Chatterjees left. There is no shame in admitting that physical examination skills are poor to middling for most other modern-day physicians. For them and their patients, HHU may be the answer. It is time to move on!
- American College of Cardiology Foundation