Diagnosing heart failure among acutely dyspneic patients with cardiac, inferior vena cava, and lung ultrasonography

Anderson, Kenton L.; Jenq, Katherine Y.; Fields, J. Matthew; Panebianco, Nova L.; Dean, Anthony J.

doi:10.1016/j.ajem.2013.05.007

Cited by 133 publications

(137 citation statements)

References 59 publications

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“…The significant value of lung ultrasound for the diagnosis of acute respiratory failure has also been suggested [9,10]. Recently, the interest of early chest ultrasonography for the diagnosis of severe dyspnea cases admitted into intensive care units has been shown [11], but there is little data concerning acute dyspnea in the ED [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic performance of cardiopulmonary ultrasound performed by the emergency physician in the management of acute dyspnea

Gallard¹,

Redonnet²,

Bourcier³

et al. 2015

The American Journal of Emergency Medicine

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Section: Introductionmentioning

confidence: 99%

Diagnostic performance of cardiopulmonary ultrasound performed by the emergency physician in the management of acute dyspnea

Gallard¹,

Redonnet²,

Bourcier³

et al. 2015

The American Journal of Emergency Medicine

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“…La precisión diagnóstica de la ecografía clínica para el diagnós-tico de neumonía es del 86% y para el EPOC o asma del 95% 5 . La ecografía pulmonar es más sensible (> 95%) y especí-fica (95%) que la determinación de péptidos natriuréticos (sensibilidad 75%-85% y especificidad 60%-80%) para el diagnóstico de insuficiencia cardiaca aguda 3,21,24,27 La ecografía clínica puede realizarse antes de que el paciente con disnea llegue al hospital (medio extrahospitalario) y, por tanto, orientar el diagnóstico e iniciar el tratamiento específico con una alta fiabilidad 27 La ecografía cardiaca, pulmonar y del sistema venoso profundo de extremidades inferiores permite establecer el diagnóstico de embolia de pulmón con una sensibilidad del 90% y una especificidad del 86% Figura 15. Ecografía por compresión simplificada del sistema venoso profundo proximal.…”

Section: Técnicaunclassified

Utilidad de la ecografía clínica en el diagnóstico del paciente con disnea

2016

Gal. Clin.

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IntroducciónLa disnea es un síntoma frecuente. Tiene una amplia variedad de posibilidades etiológicas y no siempre resulta sencillo establecer un diagnóstico correcto, especialmente en personas ancianas, obesas o en pacientes con antecedentes de enfermedad pulmonar obstructiva crónica (EPOC). La disnea puede deberse a procesos potencialmente graves en los que un diagnóstico precoz y el inicio del tratamiento médico adecuado son muy importantes 1, 2 . El desarrollo de equipos ecográficos portátiles y de gran calidad a un precio asequible ha permitido una enorme difusión de ecografía en múltiples especialidades (medicina interna, urgencias, cuidados intensivos, anestesia, reumatología, neumología, etc. ). La ecografía clínica, es decir, la realizada por el médico directamente responsable del paciente a pie de cama facilita el diagnóstico precoz del enfermo con disnea en múltiples ámbitos (urgencias, planta de hospitalización, unidades de cuidados intensivos y reanimación), incluido el medio extrahospitalario 3 . Etiología de la disneaEn la tabla 1 mostramos las causas más frecuentes de disnea. En la mayoría de los casos la disnea está relacionada con patología respiratoria o cardiaca, aunque existen diagnósticos alternativos. A pesar de una correcta valoración clínica inicial, en un porcentaje significativo de pacientes no se puede establecer con exactitud la etiología de la disnea y existen al menos dos o más posibilidades diagnósticas. De esta forma surge el concepto de "disnea indiferenciada" (tabla 2) 2 . Un reto diagnóstico, por ejemplo, es la agudización del enfermo con EPOC que puede ser debida a múltiples circunstancias (infección respiratoria, embolia de pulmón, neumotórax, insuficiencia cardiaca, cáncer de pulmón). Evaluación diagnóstica del paciente con disneaLa base del diagnóstico del enfermo con disnea se sustenta en la historia clínica y exploración física. Dependiendo de la valoración clínica inicial se solicitan, si es necesario, pruebas complementarias para esclarecer su etiología. Entre las Correspondencia:

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“…The skilled sonologist can add cardiac and IVC views to the lung scan. Expert operator trials 19 and small groups have been successful in this practice 7 16 , 17 , 30 , 31 The addition of further cardiac or IVC views appears feasible for inexpert sonologists, even if the clips are read at a later date by an experienced practitioner.…”

Section: Recognition Of Patients With Other Lung Pathologymentioning

confidence: 99%

“…Clinicians are striving to understand the best way to use this new tool, but the tool has limitations. When predicting pulmonary oedema, the B line appears to have reached a ceiling 5 – 7 trading off between sensitivity and specificity. New_research seeks to improve B line test characteristics by altering sample selection, protocols or reference definitions.…”

Section: Introductionmentioning

confidence: 98%

Lung ultrasound in heart failure: Lessons from re‐analysis of Lung Ultrasound 2011 database

Baker

Mitchell

Thompson

et al. 2015

Australas J Ultrason Med

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Introduction: In the setting of patients presenting with shortness of breath to an Emergency Department a simple lung ultrasound protocol aimed at detecting pulmonary oedema has been shown to have diagnostic accuracy of 85%. This article reviews data from the original study, in an attempt to determine whether adjusting the protocol and/or interpretive criteria would improve results. Method: A large lung ultrasound project provided the dataset. Inter‐rater and intertest discrepancies were reviewed. Then original stored images and comments were retrospectively analysed using alternate interpretive criteria. Specific variations included changing the number of B‐lines required to define ‘wet lung’ and assessing other pleural line abnormalities. Where they had been acquired cardiac loops were reviewed in addition to the lung images. Results: The 204 original studies available were reviewed. Some disagreement could be attributed to inexperience and unclear definitions. Adjusting the number of B‐lines did not improve diagnostic accuracy. All positive scans, with numerous B‐lines were reviewed using more advanced diagnostic criteria (pleural line abnormalities) and the number of false positives was decreased. In cases where cardiac views were available, their inclusion was beneficial. Conclusion: A simple lung ultrasound protocol to assess for ‘wet lung’ in patients presenting to Emergency Departments provides diagnostic accuracy of around 85% in the hands of relative novices. More advanced interpretation of the same_ultrasound images, and the addition of cardiac views, is likely to further improve diagnostic accuracy.

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Diagnosing heart failure among acutely dyspneic patients with cardiac, inferior vena cava, and lung ultrasonography

Cited by 133 publications

References 59 publications

Diagnostic performance of cardiopulmonary ultrasound performed by the emergency physician in the management of acute dyspnea

Diagnostic performance of cardiopulmonary ultrasound performed by the emergency physician in the management of acute dyspnea

Utilidad de la ecografía clínica en el diagnóstico del paciente con disnea

Lung ultrasound in heart failure: Lessons from re‐analysis of Lung Ultrasound 2011 database

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