CHF mislabeled as COPD

Robert Bell rmsbell200 at YAHOO.COM
Sat Jan 25 05:52:50 UTC 2014


Another problem is embolism being labelled heart trouble, and bronchiectasis, TB and MAC infections called asthma. Similar diagnostic problems. Further history and lab work, including Factor V Leidin, etc. And X-ray or CT might help to differentiate.

However, we do not know if the stethoscope in different hands is more dangerous than helpful - and this after 150 years of stethoscope use. I have wondered if the studies are resisted because the stethoscope is associated with physicians/HCPs and is essentially their status symbol. How would HCPs react/feel if evidence based medicine recommended the stethoscope only be used for blood pressure measurements in those with say less that 10 years of experience? Or something like that. Are we keeping an inaccurate instrument around because of its role as a status symbol? I am not sure. 

Rob Bell, MD., Ph.C.

Sent from my iPad

On Jan 22, 2014, at 8:57 AM, Karen Cosby <kcosby40 at GMAIL.COM> wrote:

> Yes we recognize this is a common problem, although more with patients labeled as asthma.  In part it's because both conditions may occur in the same patient.  Patients in the ED often have longstanding and poorly controlled asthma/COPD, and many have right heart failure with edema. Detecting new CHF in those patients can be difficult.  It even more problematic because asthmatics in many EDs are triaged to an area where they are treated in chairs and aren't undressed for a full exam.  We recognized this as a problem and developed standard questionnaires for examiners to complete specifically targeting questions to elicit signs and symptoms that might require a more thorough exam/evaluation for alternative conditions.  We tell our residents that one of the main priorities we expect in the evaluation of asthma is to detect conditions other than asthma.  We haven't tried to quantitate this problem, but have it among our list of common causes of mis-diagnoses.  
> 
> 
> On Mon, Jan 20, 2014 at 9:22 PM, Abdul Saadi <essadii at gmail.com> wrote:
> Anyone aware of good literature on the mislabeling of CHF as COPD? Is there any estimates. Is this a problem that anyone sees with any frequency or is it just me? Is it slipping stethoscope skills or failure to take into account the whole patient presenation?
> 
> Abdul Saadi,MD
> Temple University
> 
> 
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