scholarly journals Stay Still’s for POCUS: using bedside ultrasound to screen for cardiac complications

2021 ◽  
Vol 2021 (7) ◽  
Author(s):  
Justin Choi ◽  
Christopher T Kelly ◽  
Francis C Luk
Keyword(s):  
Heart Failure ◽  
Pericardial Effusion ◽  
Cardiac Imaging ◽  
Point Of Care ◽  
Unknown Etiology ◽  
Cardiac Complications ◽  
Point Of Care Ultrasound ◽  
Inflammatory Disorder ◽  
Adult Still's Disease ◽  
Lethal Complications

ABSTRACT Adult Still’s disease (ASD) is a rare systemic inflammatory disorder of unknown etiology most commonly characterized by daily spiking fevers, an evanescent, ‘salmon-colored’ rash, and arthralgia. Cardiac complications such as pericarditis, myocarditis, heart failure, and pericardial effusion progressing to tamponade have been reported. Because of the severe and potentially lethal complications associated with these processes, the clinician’s index of suspicion must remain high and the threshold for cardiac imaging low. Here, we present a case of ASD-associated myocarditis identified quickly by point-of-care ultrasound, allowing for prompt workup and treatment.

scholarly journals The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Matthew G. Hanson ◽  
Barry Chan
Keyword(s):  
Pericardial Effusion ◽  
Point Of Care ◽  
Physical Exam ◽  
Right Atrial ◽  
Point Of Care Ultrasound ◽  
X Ray ◽  
Average Systolic Blood Pressure ◽  
Time To Diagnosis ◽  
Clinically Significant ◽  
The Impact

Abstract Background Symptomatic pericardial effusion (PCE) presents with non-specific features and are often missed on the initial physical exam, chest X-ray (CXR), and electrocardiogram (ECG). In extreme cases, misdiagnosis can evolve into decompensated cardiac tamponade, a life-threatening obstructive shock. The purpose of this study is to evaluate the impact of point-of-care ultrasound (POCUS) on the diagnosis and therapeutic intervention of clinically significant PCE. Methods In a retrospective chart review, we looked at all patients between 2002 and 2018 at a major Canadian academic hospital who had a pericardiocentesis for clinically significant PCE. We extracted the rate of presenting complaints, physical exam findings, X-ray findings, ECG findings, time-to-diagnosis, and time-to-pericardiocentesis and how these were impacted by POCUS. Results The most common presenting symptom was dyspnea (64%) and the average systolic blood pressure (SBP) was 120 mmHg. 86% of people presenting had an effusion > 1 cm, and 89% were circumferential on departmental echocardiogram (ECHO) with 64% having evidence of right atrial systolic collapse and 58% with early diastolic right ventricular collapse. The average time-to-diagnosis with POCUS was 5.9 h compared to > 12 h with other imaging including departmental ECHO. Those who had the PCE identified by POCUS had an average time-to-pericardiocentesis of 28.1 h compared to > 48 h with other diagnostic modalities. Conclusion POCUS expedites the diagnosis of symptomatic PCE given its non-specific clinical findings which, in turn, may accelerate the time-to-intervention.

Abstract 16244: Point of Care Ultrasound of the Jugular Venous Pulse in the Upright Position (u 2 Jvp) Predicts Elevated Right Atrial Pressure and Pulmonary Capillary Wedge Pressure on Right Heart Catheterization in Obese and Non-obese Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Libo Wang ◽  
Jonathan Harrison ◽  
Elizabeth Dranow ◽  
Lillian Khor
Keyword(s):  
Heart Failure ◽  
Predictive Value ◽  
Point Of Care ◽  
Right Heart Catheterization ◽  
Upright Position ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Point Of Care Ultrasound ◽  
Right Heart ◽  
Clinically Significant

Introduction: Accurate intravascular volume status assessment is central to heart failure management, but current non-invasive bedside techniques remain a challenge. The visual inspection of jugular venous pulsation (JVP) in a reclined position and measuring its height from the sternal notch has been used as a surrogate for right atrial pressure (RAP). There are no studies on the predictive value of a visible internal jugular vein (IJV) in the upright position (U 2 JVP). Hypothesis: Point of care ultrasound (POCUS) for volume assessment in the upright position is predictive of clinically significant hypervolemia. Methods: Adult patients undergoing right heart catheterization (RHC) were enrolled prior for IJV imaging with point of care ultrasound (POCUS) device, Butterfly iQ™. The IJV and its size in comparison to the carotid artery was identified on ultrasound with the patient upright. Elevated RAP and PCWP was present if the IJV was still visible and not collapsed throughout the entirety of the respiratory cycle. Valsalva was used to confirm the position of a collapsed IJV. Results: 72 participants underwent U 2 JVP assessment on the same day prior to RHC. Average BMI was 31.9 kg/m2. The area under the curve (AUC) of U 2 JVP predicting RAP greater than 10 mmHg and PCWP of 15 mmhg or higher on RHC was 0.78 (95% CI 0.66-0.9, p<0.001), with AUC of 0.86 and 0.74 for non-obese and obese subgroups respectively, p= 0.38. The finding of a visible U 2 JVP in the upright position was 70.6 % sensitive and 85.5 % specific with a negative predictive value of 90.4% for identifying both RAP greater than 10 mmHg and PCWP equal or greater than 15 mmHg. Conclusions: The U 2 JVP is novel and pragmatic bed-side approach to the assessment of clinically significant elevated intra-cardiac pressures in our increasingly obese heart failure population.

scholarly journals Point-of-care Echocardiogram as the Key to Rapid Diagnosis of a Unique Presentation of Dyspnea: A Case Report

2020 ◽  
Vol 4 (3) ◽  
pp. 424-427
Author(s):  
Michael Moore ◽  
Brian Dilcher ◽  
Joseph MInardi ◽  
Kimberly Quedado ◽  
Erica Shaver
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Respiratory Symptoms ◽  
Point Of Care ◽  
Diagnostic Error ◽  
Left Ventricular ◽  
Rapid Diagnosis ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Ventricular Thrombus

Introduction: Dyspnea is commonly evaluated in the emergency department (ED).The differential diagnosis is broad. Due to the large volume of dyspneic patients evaluated, emergency physicians (EP) will encounter uncommon diagnoses. Early, liberal application of point-of-care ultrasound (POCUS) may decrease diagnostic error and improve care for these patients. Case Report: We report a 48-year-old male presenting to the ED with cough and progressively worsening dyspnea for 11 months after multiple healthcare visits. Using POCUS, the EP was immediately able to diagnose a severe dilated cardiomyopathy (DCM) with left ventricular thrombus. Conclusion: Given that non-ischemic DCM is one of the most common etiologies of heart failure, often presenting with respiratory symptoms, POCUS is key to rapid diagnosis and, along with modalities such as electrocardiography and chest radiograph, should be standard practice in the workup of dyspnea, regardless of age or comorbidities.

scholarly journals P122: The evaluation of various point of care ultrasound features in Stanford type A aortic dissections

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S109-S109
Author(s):  
T. Chiang ◽  
G. Puri
Keyword(s):  
Emergency Department ◽  
Pericardial Effusion ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Chart Review ◽  
Point Of Care ◽  
Retrospective Chart Review ◽  
Type A ◽  
Point Of Care Ultrasound ◽  
D Dimer

Introduction: Type A aortic dissection(AD) is one of the most lethal diseases in medicine. Its mortality rate increases 1-2% per hour from the onset of symptoms to treatment. Timely diagnoses of ADs, therefore, are crucial to improve survival and decrease morbidity. There are various proposed clinical guidelines to help emergency physicians decide when a CTA is urgently needed with most widely quoted being the validated Aortic Dissection Detection Risk Score(ADD-RS) recommended by the American Heart Association. The addition of D-Dimer for further risk stratification has also been entertained. A recent article published in the American Journal of Emergency recommends using point of care ultrasound(POCUS) to expedite diagnosis. With the rising use of POCUS in the emergency department, it can be the missing link to timely AD diagnoses. This project aims to elucidate the prevalence of positive POCUS findings (pericardial effusion and dilated aortic root) in type A AD via a retrospective chart review. Methods: This study is a retrospective chart review of 200 patients with the diagnosis of AD treated at Southlake Regional Hospital. We included patients diagnosed with type A AD and excluded those diagnosed with type B AD. We collected data on their demographics, ADD-RS scores, investigation results, treatments, and clinical outcomes. The main focus of the chart review was on the presence of pericardial effusion or dilated aortic root on echocardiograms. Binomial statistical analysis was used to analyze the collected data. Results: We identified 126 patients with type A AD out of 200 charts reviewed. Thirteen (14% CI 8-23%, n = 93 p = 0.05) had wide mediastinum on their chest X-rays; twenty (95% CI 75-100%, n = 21 P = 0.05) had elevated D-dimer levels; and ninety-one (72% CI 64-80%, n = 126 p = 0.05) had positive ADD-RS. Only 88 out of 126 AD cases had documented echocardiograms. Sixty-eight (77% CI 67-86%, n = 88 p = 0.05) had either pericardial effusions or dilated aortic roots on their echocardiograms. Eighty-one (92% CI 84-95%, n = 88 p = 0.05) had either positive ADD-RS or positive echocardiogram findings, which is 20 (23% CI 14-33%, n = 88 P = 0.05) more cases than ADD-RS would have picked up alone. Conclusion: The absence of both pericardial effusion and dilated aortic root on echocardiogram in combination with a negative ADD-RS has a high sensitivity for ruling out type A AD. Our data support further research into the use of POCUS to expedite the diagnosis of type A AD in the emergency department.

scholarly journals A Case Report of Acute Heart Failure Due to Infective Aortic Endocarditis Diagnosed by Point-of-care Ultrasound

2020 ◽  
Vol 4 (2) ◽  
pp. 193-196
Author(s):  
Ryan Gallagher ◽  
Michelle Wilson ◽  
Pamela Hite ◽  
Bradley Jackson
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Aortic Valve ◽  
Acute Heart Failure ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Complication Rates ◽  
Threatening Condition ◽  
Valve Insufficiency ◽  
Life Threatening

Introduction: Infective endocarditis (IE) is a life-threatening condition with significant morbidity and mortality, and can require surgical repair. Case Report: A 36-year-old man presented to the emergency department for worsening dyspnea and chest pain. Point-of-care echocardiography demonstrated a mobile oscillating mass on the aortic valve with poor approximation of the valve leaflets, suggesting aortic valve insufficiency secondary to IE as the cause of acute heart failure. The patient underwent emergent aortic valve replacement within 24 hours. Discussion: While point-of-care echocardiography has been well documented in identifying tricuspid vegetations, aortic valve involvement and subsequent heart failure is less well described. Earlier recognition of aortic valve vegetations and insufficiency can expedite surgical intervention, with decreased complication rates linked to earlier antimicrobial therapy. Conclusion: This case report highlights the ability of point-of-care ultrasound to identify aortic vegetations, allowing for the earlier diagnosis and therapy.

scholarly journals Point-of-Care Ultrasound Identifies Decompensated Heart Failure in a Young Male with Methamphetamine-Associated Cardiomyopathy Presenting in Severe Sepsis to the Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
David Kinas ◽  
Michael Dalley ◽  
Kayla Guidry ◽  
Mark A. Newberry ◽  
David A. Farcy
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Severe Sepsis ◽  
Point Of Care ◽  
Disease Process ◽  
Young Male ◽  
Decompensated Heart Failure ◽  
The United States ◽  
Point Of Care Ultrasound ◽  
Methamphetamine Abuse

We describe a case of a young male who presents to the emergency department with severe sepsis and decompensated heart failure with underlying Methamphetamine-Associated Cardiomyopathy that was previously undiagnosed. This presentation is unique because Methamphetamine-Associated Cardiomyopathy is an uncommonly reported condition that presented in a complex clinical scenario of severe sepsis and decompensated congestive heart failure. We discuss how we used point-of-care ultrasound (POCUS) in this case to identify an unsuspected disease process and how it changed our initial resuscitation strategy and management. Emergency physicians can utilize point-of-care ultrasound (POCUS) to help identify these high-risk patients in the emergency department and guide appropriate resuscitation. Methamphetamine-Associated Cardiomyopathy (MAC) is an infrequently described complication of methamphetamine abuse, most commonly presented as a nonischemic dilated cardiomyopathy. With the rise in methamphetamine abuse in the United States, complications from methamphetamine use are more commonly presenting to the emergency department. Proper education and rehabilitation, with a goal of abstinence from amphetamine use, may allow patients to potentially regain normal cardiac function. Since the majority of patients present late with severe cardiac dysfunction, early detection is essential amongst critically ill patients since recognition may significantly influence ED management.

scholarly journals Dynamic Changes in Portal Vein Flow during Decongestion in Patients with Heart Failure and Cardio-Renal Syndrome: A POCUS Case Series

2021 ◽  
pp. 1-8
Author(s):  
Eduardo R. Argaiz ◽  
Philippe Rola ◽  
Gerardo Gamba
Keyword(s):  
Heart Failure ◽  
Portal Vein ◽  
Point Of Care ◽  
Vena Cava ◽  
Case Series ◽  
Kidney Injury ◽  
Venous Congestion ◽  
Point Of Care Ultrasound ◽  
Optimal Method ◽  
Portal Vein Flow

<b><i>Introduction:</i></b> Optimal method for noninvasive assessment of venous congestion remains an unresolved issue. Portal vein (PV) and intrarenal venous flow alterations are markers of abdominal venous congestion and have been associated with acute kidney injury (AKI) in cardiac surgery patients. It is currently unknown if portal vein flow (PVF) alterations in heart failure can be reversed with diuretic treatment and track decongestion. <b><i>Objective:</i></b> The aim of this study is to evaluate PVF alterations in patients with ADHF at arrival and after decongestive treatment. <b><i>Methods:</i></b> Assessment of venous congestion using point-of-care ultrasound was performed in 12 patients with ADHF (6 patients with left-sided heart failure and 6 patients with right-sided heart failure). Evaluation included inferior vena cava (IVC) size and collapsibility in addition to PV Doppler to determine pulsatility fraction (PF). <b><i>Results:</i></b> Increased PV PF (81.75 ± 13%) was found on admission. After effective decongestive treatment, it improved to (17.43 ± 2.2%). Improvement in IVC size and collapsibility was seen in most patients with left-sided heart failure and none of the patients with right-sided heart failure. Improvement in PV PF coincided with return to baseline of Serum Cr in patients that presented with AKI. <b><i>Conclusions:</i></b> Evaluation of abdominal venous congestion by point-of-care ultrasound could aid in diagnosis and follow-up of patients with congestive kidney injury.

Sign in / Sign up

Export Citation Format

Share Document