European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Review Case Reports
Heart failure with preserved ejection fraction: echocardiographic VALVE protocol for emergency physicians.
Heart failure with preserved ejection fraction, previously called diastolic heart failure, has been recognized to account for heart failure in about half the total population of patients with heart failure. These patients can present with the signs and symptoms of acute heart failure. ⋯ These findings can aid in the recognition of patients who present with heart failure with preserved ejection fraction. The authors will discuss a focused stepwise approach, namely the VALVE protocol, suitable for the fast-paced emergency department.
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The main purpose of this article is to provide some practical insights into acid-base disorders interpretation, comparing the three most widespread diagnostic approaches. After a brief summary of the history of blood gas analysis and the shift from a purely chemical approach to more clinically useful applications, the pros and cons of the different methodologies are compared and discussed. Reviewing the most important publications in the field, the authors attempt to show that each diagnostic strategy is acceptable, although the one based on base-excess calculation perhaps seems too 'rough' to understand the mixed disorders, whereas the Stewart approach is attractive from a chemical point of view, but unsuitable for the emergency physician because of the cumbersome calculations needed. Finally, the anion gap and 'expected compensation' approach seems to be more comprehensive and feasible at the bedside.