Limited bedside echocardiography by emergency physicians for diagnosis of diastolic heart failure

Ünlüer, Erol Erden; Bayata, Serdar; Postaci, Nursen; Yeşìl, Murat; Yavaşı, Özcan; Kara, Pınar Hanife; Vandenberk, Nergis; Akay, Serhat

doi:10.1136/emj.2011.111229

Cited by 40 publications

(29 citation statements)

References 26 publications

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“…In our study, many patients with atrial fibrillation (39%) were not excluded, although LVFP is known to be difficult to assess [26,28]. This limitation is not found in the literature where patients with atrial fibrillation were excluded and ultrasound parameters used without gray area [29][30][31][32]. This explains the inability of the cardiac ultrasound in our study to evaluate the LVFP for 45% of patients and stresses the need for coupling cardiac with lung ultrasound.…”

Section: Discussionmentioning

confidence: 90%

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: Discussionmentioning

confidence: 90%

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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“…Nowadays, it has lent itself to the evaluation and management of most patients through the incorporation of multiple ultrasound examinations within a single patient encounter. [456] The information gained can provide crucial information at the bedside, which can enhance diagnostic certainty and guide management.…”

Section: Discussionmentioning

confidence: 99%

Bedside ultrasound diagnosis of intracardiac paperclip

Ünlüer

Karagöz

Topal

et al. 2014

J Emerg Trauma Shock

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Penetrating cardiac injuries are rarely reported in the literature. Foreign bodies are rarely seen in the heart and most patients with penetrating cardiac injuries die from hemorragic or pericardial tamponade before arriving at the hospital. Bedside ultrasonography is a highly valuable and readily learned tool that has expanded rapidly since its introduction more than 20 years ago. Our case was a 23-year-old convict brought to the emergency department (ED) with a history of continuous chest pain in the upper area of the left side of the chest for one week. Focused Cardiac Sonography (FOCUS) which was performed by emergency physician showed a strong echogenic linear structure with comet tail artifact, free floating in the mid-segment of the left ventricule. Exact localizations of the paperclips within the chest was obtained with multidetector computed tomography and one of them was seen in the left ventricular cavity. FOCUS plays a crucial role in these patients by diagnosing the injury and detecting the complications in emergency department.

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“…Over the past two decades, there has been considerable enthusiasm for the development and use of FOCUS for assessing patients admitted to the ED with the complaint of dyspnea . Most of the studies designed within the ED have primarily focused on a visual estimation of LVEF rather than calculations involving the measurement of LV chamber dimensions throughout the cardiac cycle .…”

Section: Discussionmentioning

confidence: 99%

“…Studies in intensive care units have shown that echocardiography may supplement or replace invasive measures of volume status and have provided information about short‐ and long‐term prognosis . The use of focused cardiac ultrasound ( FOCUS ) within the emergency department ( ED ) has historically provided both prognostic information for patients with suspected cardiac ischemia and diagnostic clues about diastolic heart failure . Studies have also demonstrated that experienced emergency physicians ( EP s) with additional FOCUS training can accurately assess LVEF in ED patients with acute dyspnea .…”

mentioning

confidence: 99%

An Alternative Approach to the Bedside Assessment of Left Ventricular Systolic Function in the Emergency Department: Displacement of the Aortic Root

Ünlüer

Karagöz

Bayata

et al. 2013

Academic Emergency Medicine

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Objectives: Left ventricular ejection fraction (LVEF) is a crucial parameter in the management of patients with dyspnea in the emergency department (ED). The use of techniques other than echocardiography such as nuclear or magnetic resonance imaging to measure LVEF is unsuitable in the ED because of time constraints. This study aimed to compare echocardiographic aortic root (AR) excursion and LVEF measurement using the modified Simpson's method (biplane method of disks) as recommended by the American Society of Echocardiography. Methods: After 2 hours of theoretical video and hands-on training with 20 patients by an experienced echocardiographer, two emergency physicians prospectively evaluated patients with dyspnea. Two-dimensional echocardiograms of the parasternal long-axis view were obtained, and the displacement of the aortic root (DAR) was studied. M-mode DAR recordings were obtained, and distances were measured as the maximized anterior displacement of the AR from the horizontal axis at end-systole by using the leading-edge methodology. LVEF was measured by an experienced cardiologist using the modified Simpson's rule. The sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-), and positive and negative predictive values (PPV, NPV) were analyzed. A new formula for the prediction of the ejection fraction (EF) with the aid of DAR was then created. Results: The mean (AESD) age with of the 70 study patients was 69.7 (AE11.91) years. In these patients, DAR was highly correlated with EF (point biserial correlation coefficient = 0.79, p < 0.001) and one-way analysis of variance (ANOVA) results were significant (F = 115.9; p < 0.001). The sensitivity was 94.4; specificity, 94.1; LR+, 16.6; LR-, 0.059; PPV, 94.4; and NPV, 94.1. Conclusions: The results indicate that DAR is a sensitive index of left ventricular systolic function (SF) and can be used to reliably predict EF values using the rough formula of EF = 20 + 44 (DAR). ACADEMIC EMERGENCY MEDICINE 2013; 20:367-373 O ptimizing cardiac performance is an important goal in the management of critical illnesses. Physical examination has proven unreliable for differentiating between cardiogenic and noncardiogenic causes of hypotension, 1,2 and rapid determination of left ventricular ejection fraction (LVEF) may have important implications for patient diagnosis and treatment. 3,4 Studies in intensive care units have shown that echocar-diography may supplement or replace invasive measures of volume status and have provided information about short-and long-term prognosis. 5-11 The use of focused cardiac ultrasound (FOCUS) within the emergency department (ED) has historically provided both prognostic information for patients with suspected cardiac ischemia and diagnostic clues about diastolic heart failure. 12-15 Studies have also demonstrated that experienced emergency physicians (EPs) with additional FOCUS training can accurately assess LVEF in ED patients with acute dyspnea. 16-18 Because of the limited time available for ED patient evaluation, t...

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Limited bedside echocardiography by emergency physicians for diagnosis of diastolic heart failure

Abstract: BECH performed by emergency physicians may serve as an objective, rapid, non-invasive tool in the assessment of patients presenting with dyspnoea in ED.

Cited by 40 publications

References 26 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

Bedside ultrasound diagnosis of intracardiac paperclip

An Alternative Approach to the Bedside Assessment of Left Ventricular Systolic Function in the Emergency Department: Displacement of the Aortic Root

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