Taking heart failure seriously

[...]patients identified by simple tests as likely to have heart failure need echocardiography to confirm the diagnosis and establish its probable cause. [...]echocardiography forms a focal point on which most patients with suspected heart failure will converge. Other analyses of these data indicate that the risk of hypotension with the first dose in symptomatic patients is higher than in non-symptomatic patients (see table on the BMJ's website). [...]it is inappropriate to draw firm conclusions about the safety of starting angiotensin converting enzyme inhibitors in primary care from an analysis of the SOLVD dataset.