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    Shortness of breath in clinical practice: A case for left atrial function and exercise stress testing for a comprehensive diastolic heart failure workup.

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    Author
    Iyngkaran, P; Anavekar, NS; Neil, C; Thomas, L; Hare, DL
    Date
    2017-12-26
    Source Title
    World Journal of Methodology
    Publisher
    Baishideng Publishing Group Inc.
    University of Melbourne Author/s
    Anavekar, Nagesh; Hare, David
    Affiliation
    Medicine and Radiology
    Medicine, Northern Health
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Iyngkaran, P., Anavekar, N. S., Neil, C., Thomas, L. & Hare, D. L. (2017). Shortness of breath in clinical practice: A case for left atrial function and exercise stress testing for a comprehensive diastolic heart failure workup.. World J Methodol, 7 (4), pp.117-128. https://doi.org/10.5662/wjm.v7.i4.117.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/255980
    DOI
    10.5662/wjm.v7.i4.117
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5746665
    Abstract
    The symptom cluster of shortness of breath (SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.

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