ABSTRACT: Heart failure has a low incidence in general practice but is not easy to recognize in this setting. Frequently a normal electrocardiogram
and a normal level of brain natriuretic peptide can exclude heart failure as a cause for dyspnea. Unfortunately the positive
predictive value of both techniques is low. Imaging with echocardiography can then give the clue to the correct diagnosis.
Also correct diagnosis of cardiac murmurs is not easy in general practice. Therefore an open access echocardiographic service
was established in the south of the Netherlands. According to the existing services in the United Kingdom general practicioners
in this area were able to ask for an echocardiogram without referring the patient to the cardiologist. During a period of
19months 131 patients were referred to the Centre of Medical Diagnostics for an echocardiogram. In 12% of the patients referred
for dyspnea a left ventricular ejection fraction lower than 40% was found. Fourty nine percent of the patients had diastolic
dysfunction. In 33% heart failure could be excluded. In 62% of the patients referred for a cardiac murmur cardiac pathology
could be found. In 38% of the patients the cardiac murmur could be established as a functional murmur. The service was found
to improve practice by most of the general practicioners.
The International Journal of Cardiovascular Imaging 04/2012; 22(1):19-25. · 2.29 Impact Factor