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Focused cardiac ultrasound using a pocket-size device in the emergency room.

Mancuso FJ, Siqueira VN, Moisés VA, Gois AF, Paola AA, Carvalho AC, Campos O - Arq. Bras. Cardiol. (2014)

Bottom Line: Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions.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.

View Article: PubMed Central - PubMed

Affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Background: Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions.

Objective: To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care.

Methods: One 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.

Results: The 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.

Conclusion: The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.

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Vscan device (GE Healthcare) used in this study.
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f01: Vscan device (GE Healthcare) used in this study.

Mentions: FoCUS scans were carried out using the ultra-portable Vscan device (GE Healthcare,Milwaukee, Wisconsin, USA) shown in Figure 1,and were performed by a single cardiologist. FoCUS scans were was carried out in atargeted manner and at the patient's bedside shortly after the initial clinicalevaluation and ECG reading, with the goal of resolving doubts about the diagnosis.Subjective analysis was performed on the two-dimensional images and color flowmapping, focusing on the following aspects: the dimensions of the cavities, globalsystolic function, evaluation of segmental and global contractility of the leftventricle (LV), right ventricular systolic function, anatomical appearance of themitral and aortic valves, presence of significant mitral and aortic valveregurgitation, presence of indirect signs of pulmonary hypertension (dilatation ofthe right chambers, bulging of the interventricular septum to the left, dilatation ofthe pulmonary trunk), presence of pericardial effusion, assessment of the dimensionsof the thoracic aorta (ascending aorta and aortic arch), and presence of a dissectionline.


Focused cardiac ultrasound using a pocket-size device in the emergency room.

Mancuso FJ, Siqueira VN, Moisés VA, Gois AF, Paola AA, Carvalho AC, Campos O - Arq. Bras. Cardiol. (2014)

Vscan device (GE Healthcare) used in this study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4290744&req=5

f01: Vscan device (GE Healthcare) used in this study.
Mentions: FoCUS scans were carried out using the ultra-portable Vscan device (GE Healthcare,Milwaukee, Wisconsin, USA) shown in Figure 1,and were performed by a single cardiologist. FoCUS scans were was carried out in atargeted manner and at the patient's bedside shortly after the initial clinicalevaluation and ECG reading, with the goal of resolving doubts about the diagnosis.Subjective analysis was performed on the two-dimensional images and color flowmapping, focusing on the following aspects: the dimensions of the cavities, globalsystolic function, evaluation of segmental and global contractility of the leftventricle (LV), right ventricular systolic function, anatomical appearance of themitral and aortic valves, presence of significant mitral and aortic valveregurgitation, presence of indirect signs of pulmonary hypertension (dilatation ofthe right chambers, bulging of the interventricular septum to the left, dilatation ofthe pulmonary trunk), presence of pericardial effusion, assessment of the dimensionsof the thoracic aorta (ascending aorta and aortic arch), and presence of a dissectionline.

Bottom Line: Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions.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.

View Article: PubMed Central - PubMed

Affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Background: Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions.

Objective: To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care.

Methods: One 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.

Results: The 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.

Conclusion: The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.

Show MeSH
Related in: MedlinePlus