Clinical features

• tachycardia ^b
• hypotension or hypertension ^b
• dyspnoea ^{a b}
• crackles on chest examination ^b
• oedema ^{a b}

Note:

More clinical features increase the chance of a reduced ejection fraction

Number of clinical features b	Prevalence of reduced ejection fraction
3 or more	> 83%
1 or 2 features	23% to 41%
no features	< 10%

Why?

Clinical features can help diagnose increased filling pressure, a low ejection fraction and diastolic dysfuncion

Features b	increased filling pressure	ejection fraction < 40%	diastolic dysfunction
very helpful	radiographic distribution raised JVP	radiographic cardiomegaly or redistribution anterior Q waves LBBB abnormal apical impulse	current hypertension (systolic > 160, diastolic > 100)
somewhat helpful	dyspnoea orthopnoea tachycardia decreased systolic blood pressure proportional pulse pressure [(systolic-diastolic)/systolic < 25%] third heart sound abnormal abdominojugular reflex radiographic cardiomegaly	pulse > 90 systolic blood pressure < 90 mmHg proportional pulse pressure < 33% third heart sound crackles dyspnoea prior myocardial infarction CK > 200 in a post-infarct patient	obesity no tachycardia elderly non-smoker no coronary artery disease
helpful when positive	oedema	raised JVP oedema	normal radiographic heart size