caa a22 4500 467934673 CHVBK 20180406152953.0 cr unu---uuuuu 170328e20061201xx s 000 0 eng 10.1007/s00408-006-0024-1 doi (NATIONALLICENCE)springer-10.1007/s00408-006-0024-1 Expiratory Abdominal Rounding in Acute Dyspnea Suggests Congestive Heart Failure [Elektronische Daten] [Stephen Loring, Sean Townsend, Diana Gallagher, Heidi Matus, Elizabeth Tegins, David Feller-Kopman, Richard Schwartzstein] Patients in acute respiratory distress require rapid assessment of the cause of dyspnea. We have observed that many of those patients who are in congestive heart failure (CHF) exhibit rounding of the abdominal cross-section during expiration. We sought to evaluate the diagnostic utility of this breathing pattern in dyspneic patients presenting to an emergency department. Twenty-six subjects with dyspnea due to a variety of conditions were recruited from the emergency department at Beth Israel Deaconess Medical Center. Subjects ranged in age from 21 to 94 years and 81% were female. We measured variation in the anteroposterior and transverse diameters of the rib cage and abdomen using respiratory magnetometers and determined phase of respiration with a pneumotachometer. Investigators blinded to the subjects' identities and diagnoses interpreted measurements as indicating normal respiratory movement without expiratory abdominal rounding, slight expiratory rounding, or pronounced expiratory rounding. The likely cause of dyspnea was determined from discharge diagnoses in the medical record. Expiratory rounding was observed in 12/14 subjects with CHF and 5/12 subjects without CHF (p = 0.0186), and pronounced expiratory rounding was present in 11/14 patients with CHF and 2/12 patients without CHF (p = 0.0016). Test characteristics for the association of CHF with pronounced expiratory rounding were sensitivity 79%, specificity 83%, and predictive accuracy 81%. In patients with acute respiratory distress, expiratory abdominal rounding suggests CHF as the primary cause of dyspnea; a greater degree of rounding suggests a greater likelihood of CHF. The clinical utility of this diagnostic sign remains to be determined in a prospective study. Springer Science+Business Media, Inc., 2006 Chest wall nationallicence Thoracoabdominal nationallicence Magnetometer nationallicence Respiratory mechanics nationallicence Grunting respiration nationallicence Loring Stephen 330 Brookline Avenue, Dana 717, 02215, Boston, Massachusetts, USA aut Townsend Sean Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 02215, Boston, Massachusetts, USA aut Gallagher Diana Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 02215, Boston, Massachusetts, USA aut Matus Heidi Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center and Harvard Medical School, 02215, Boston, Massachusetts, USA aut Tegins Elizabeth Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center and Harvard Medical School, 02215, Boston, Massachusetts, USA aut Feller-Kopman David Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 02215, Boston, Massachusetts, USA aut Schwartzstein Richard Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 02215, Boston, Massachusetts, USA aut Lung Springer-Verlag; www.springer-ny.com 184/6(2006-12-01), 324-329 0341-2040 184:6<324 2006 184 408 https://doi.org/10.1007/s00408-006-0024-1 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00408-006-0024-1 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Loring Stephen 330 Brookline Avenue, Dana 717, 02215, Boston, Massachusetts, USA aut NATIONALLICENCE 700 1- Townsend Sean Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 02215, Boston, Massachusetts, USA aut NATIONALLICENCE 700 1- Gallagher Diana Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 02215, Boston, Massachusetts, USA aut NATIONALLICENCE 700 1- Matus Heidi Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center and Harvard Medical School, 02215, Boston, Massachusetts, USA aut NATIONALLICENCE 700 1- Tegins Elizabeth Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center and Harvard Medical School, 02215, Boston, Massachusetts, USA aut NATIONALLICENCE 700 1- Feller-Kopman David Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 02215, Boston, Massachusetts, USA aut NATIONALLICENCE 700 1- Schwartzstein Richard Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 02215, Boston, Massachusetts, USA aut NATIONALLICENCE 773 0- Lung Springer-Verlag; www.springer-ny.com 184/6(2006-12-01), 324-329 0341-2040 184:6<324 2006 184 408 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer