Can the internist generally spot symptoms before things get too dangerous?
AINAT BENIAMINOVITZ, MD: Well, the body does offer clues when there is a problem with the heart, such as extra heart sounds; perhaps a murmur. Typically, when people are actually manifesting signs and symptoms of congestive heart failure, then diagnosis is easy. A patient comes in and describes the symptoms. But before actual symptoms, there are subtle signs and clues that a physician can hear with a stethoscope on a very cursory exam. For instance, with a stethoscope, you can detect when veins are backed up with fluid. That is an example of a subtle sign or symptom that the patient may not even be aware of. If a doctor and patient are concerned about congestive heart failure, what is the first test that should be performed? SIMON MAYBAUM, MD: I think that the most useful test is an echocardiogram, which is essentially an ultrasound of the heart. It allows us to look, not only at the cardiac function-or the squeezing of the heart-but also at the size of the chambers to see that they’re
