Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

Abstract

BackgroundCardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions.ObjectiveTo evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care.MethodsOne hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated.ResultsThe mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection.ConclusionThe focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.

The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry

“…In German CPUs, these procedures also comprise standards in noninvasive imaging methods including echocardiography with TTE evaluation as a minimum requirement for at least unstable NSTE-ACS patients [4]. So far, echocardiography is still the first-line imaging modality in triaging cardiac disorders due to its nearly universal availability, potential use at the bedside and low cost [8,9,10,11,12,19,20,21]. Beside its mainstream ability of determining global and regional LV function as well as valvular morphology and function in real-time within minutes, its diagnostic impact within the CPU setting can be further enhanced by, for example, strain, tissue-Doppler, perfusion or speckle-track analysis [22,23,24,25].…”

Utility of Ultraportable Echocardiography in the Preoperative Evaluation of Noncardiac Surgery

“…It has been recently demonstrated that this technology has an incremental diagnostic value to cardiologic clinical examination, by increasing the number of correct diagnosis and reducing the routine use of echocardiography. 7 …”

Point‐of‐care ultrasound with pocket‐size devices in emergency department

“…The specificity of sonographic findings of pulmonary embolism has been shown to be higher than the sensitivity . Right ventricular dilatation with D‐shaped left ventricle, right heart thrombus, McConnell's sign, and deep vein thrombosis can be detected by ultrasound examination performed with handheld devices. Echographic findings of absence of pleural sliding and presence of lung point may help in identification of pneumothorax and can be detected using handheld thoracic sonography …”

“…The usefulness of integrated lung–heart ultrasound evaluation to determine chest pain etiology is established but there is lack of standardized protocols. In patients with chest pain and no certain diagnosis, after assessment of the medical history, physical examination, and ECG, focused echocardiography with pocket‐size equipment may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy …”