Acute cardiac care

Echocardiography is fundamental to the assessment and management of patients with acute cardiac disease, and differs from outpatient echocardiography in some key areas. Echocardiography provides important information throughout the whole patient pathway, having been shown to change interventions in 60–80% patients in the pre-hospital setting, improve diagnostic accuracy and efficiency in the emergency room, and reveal the aetiology of unexplained hypotension in 48% of medical intensive care patients. Echocardiography is now included in the universal definition of acute myocardial infarction, and in international guidelines regarding the management of cardiac arrest. In the critical care setting, echocardiography can be used to as a haemodynamic monitor, to determine abnormalities of cardiac physiology and coronary perfusion, as well as defining the underlying cardiac diagnosis. This chapter focuses on situations relevant to acute cardiac care, however, where discussed elsewhere in this textbook (acute coronary syndromes, pulmonary embolism, takotsubo, aortic disease, pericarditis, cardiomyopathies, heart failure, and valvular disease) they are not covered in detail here.