scholarly journals Use of point-of-care ultrasound in the management of patients presenting with shock: the treatment implications of an early bedside diagnosis of pulmonary embolism

2020 ◽  
Vol 13 (3) ◽  
pp. e233670
Author(s):  
Fiqry Fadhlillah ◽  
Maiyuran Ratneswaran
Keyword(s):  
Pulmonary Embolism ◽  
Systolic Function ◽  
Point Of Care ◽  
Pulmonary Arteries ◽  
Left Ventricular ◽  
Haemodynamic Instability ◽  
Point Of Care Ultrasound ◽  
Systemic Thrombolysis ◽  
Pulmonary Angiogram ◽  
Bedside Diagnosis

Point-of-care ultrasound has been used to identify real-time indicators of acute obstruction to right ventricular outflow and aid appropriate diagnosis and management of patients presenting with extensive pulmonary embolism in whom haemodynamic instability permits only bedside investigation. We present the case of a 70-year-old woman who presented with shock. A focused bedside echocardiography was performed and showed left ventricular septal wall flattening and a severely dilated right ventricle with impaired systolic function. The right atrium was dilated with a floating thrombus visible on the sub-xiphoid view. The patient was treated with intravenous systemic thrombolysis (alteplase) prior to undergoing CT pulmonary angiogram. This showed saddle pulmonary embolus, with extensive thrombus in the main and all lobar pulmonary arteries bilaterally, with evidence of right heart strain.

scholarly journals A near miss: subclinical saddle pulmonary embolism diagnosed by handheld ultrasound

2021 ◽  
Vol 2021 (4) ◽  
Author(s):  
Travis M Skipina ◽  
S Allan Petty ◽  
Christopher T Kelly
Keyword(s):  
Pulmonary Embolism ◽  
Point Of Care ◽  
Pulmonary Arteries ◽  
High Specificity ◽  
Near Miss ◽  
Pulmonary Vasculature ◽  
Point Of Care Ultrasound ◽  
Right Ventricular Strain ◽  
Threatening Condition ◽  
Low Sensitivity

ABSTRACT Introduction: Pulmonary embolism (PE) is a life-threatening condition characterized by occlusive disease of the pulmonary vasculature. Point-of-care ultrasound (POCUS) of right ventricular strain patterns have high specificity and low sensitivity for diagnosis. Here, we describe a patient with a saddle PE and low pre-test probability who was diagnosed primarily by handheld POCUS. Case Report: An 80-year old female was admitted to the intensive care unit with hypotension and lactic acidosis. She also had mild leukocytosis and troponinemia. No other clinical or metabolic abnormalities were present. After transfer to the floor, handheld POCUS demonstrated D-sign and McConnell’s sign. Computed tomography angiography showed a saddle PE involving both main pulmonary arteries. The patient was immediately initiated on anticoagulation without further complications. Conclusion: Handheld POCUS is inexpensive, carries a low risk of harm and is an invaluable extension of the physical exam when interpreted in the appropriate context.

scholarly journals Prognostic value of NT-proBNP for myocardial recovery in peripartum cardiomyopathy (PPCM)

2021 ◽  
Author(s):  
J. Hoevelmann ◽  
E. Muller ◽  
F. Azibani ◽  
S. Kraus ◽  
J. Cirota ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Systolic Function ◽  
Point Of Care ◽  
Diagnostic Value ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Lv Function ◽  
Myocardial Recovery ◽  
End Diastolic Volume

Abstract Introduction Peripartum cardiomyopathy (PPCM) is an important cause of pregnancy-associated heart failure worldwide. Although a significant number of women recover their left ventricular (LV) function within 12 months, some remain with persistently reduced systolic function. Methods Knowledge gaps exist on predictors of myocardial recovery in PPCM. N-terminal pro-brain natriuretic peptide (NT-proBNP) is the only clinically established biomarker with diagnostic value in PPCM. We aimed to establish whether NT-proBNP could serve as a predictor of LV recovery in PPCM, as measured by LV end-diastolic volume (LVEDD) and LV ejection fraction (LVEF). Results This study of 35 women with PPCM (mean age 30.0 ± 5.9 years) had a median NT-proBNP of 834.7 pg/ml (IQR 571.2–1840.5) at baseline. Within the first year of follow-up, 51.4% of the cohort recovered their LV dimensions (LVEDD < 55 mm) and systolic function (LVEF > 50%). Women without LV recovery presented with higher NT-proBNP at baseline. Multivariable regression analyses demonstrated that NT-proBNP of ≥ 900 pg/ml at the time of diagnosis was predictive of failure to recover LVEDD (OR 0.22, 95% CI 0.05–0.95, P = 0.043) or LVEF (OR 0.20 [95% CI 0.04–0.89], p = 0.035) at follow-up. Conclusions We have demonstrated that NT-proBNP has a prognostic value in predicting LV recovery of patients with PPCM. Patients with NT-proBNP of ≥ 900 pg/ml were less likely to show any improvement in LVEF or LVEDD. Our findings have implications for clinical practice as patients with higher NT-proBNP might require more aggressive therapy and more intensive follow-up. Point-of-care NT-proBNP for diagnosis and risk stratification warrants further investigation.

scholarly journals Fabry Cardiomyopathy: Current Practice and Future Directions

Cells ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 1532
Author(s):  
Jeffrey Yim ◽  
Olivia Yau ◽  
Darwin F. Yeung ◽  
Teresa S. M. Tsang
Keyword(s):  
Fabry Disease ◽  
Early Stage ◽  
Point Of Care ◽  
Left Ventricular ◽  
The Body ◽  
Cardiac Biomarkers ◽  
Dried Blood Spot ◽  
Point Of Care Ultrasound ◽  
Enzyme Replacement ◽  
Blood Spot

Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations in the galactosidase A (GLA) gene that result in deficient galactosidase A enzyme and subsequent accumulation of glycosphingolipids throughout the body. The result is a multi-system disorder characterized by cutaneous, corneal, cardiac, renal, and neurological manifestations. Increased left ventricular wall thickness represents the predominant cardiac manifestation of FD. As the disease progresses, patients may develop arrhythmias, advanced conduction abnormalities, and heart failure. Cardiac biomarkers, point-of-care dried blood spot testing, and advanced imaging modalities including echocardiography with strain imaging and magnetic resonance imaging (MRI) with T1 mapping now allow us to detect Fabry cardiomyopathy much more effectively than in the past. While enzyme replacement therapy (ERT) has been the mainstay of treatment, several promising therapies are now in development, making early diagnosis of FD even more crucial. Ongoing initiatives involving artificial intelligence (AI)-empowered interpretation of echocardiographic images, point-of-care dried blood spot testing in the echocardiography laboratory, and widespread dissemination of point-of-care ultrasound devices to community practices to promote screening may lead to more timely diagnosis of FD. Fabry disease should no longer be considered a rare, untreatable disease, but one that can be effectively identified and treated at an early stage before the development of irreversible end-organ damage.

scholarly journals LO042: Sonography in Hypotension and Cardiac Arrest (SHoC) - Hypotension: derivation of an evidence-based consensus algorithm for the integration of point of care ultrasound into resuscitation of hypotensive patients

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S44-S44 ◽  
Author(s):  
P. Atkinson ◽  
J. Bowra ◽  
J. Milne ◽  
M. Lambert ◽  
B. Jarman ◽  
...  
Keyword(s):  
Point Of Care ◽  
Disease Incidence ◽  
Left Ventricular ◽  
Consensus Algorithm ◽  
Professional Organizations ◽  
Clinical Indication ◽  
Point Of Care Ultrasound ◽  
International Consensus ◽  
Modified Delphi ◽  
Delphi Approach

Introduction: Point of care ultrasound has become an established tool in the initial management of patients with undifferentiated hypotension. Current established protocols (RUSH, ACES, etc) were developed by expert user opinion, rather than objective, prospective data. We wished to use reported disease incidence to develop an informed approach to PoCUS in hypotension using a “4 F’s” approach: Fluid; Form; Function; Filling. Methods: We summarized the incidence of PoCUS findings from an international multicentre RCT, and using a modified Delphi approach incorporating this data we obtained the input of 24 international experts associated with five professional organizations led by the International Federation of Emergency Medicine. The modified Delphi tool was developed to reach an international consensus on how to integrate PoCUS for hypotensive emergency department patients. Results: Rates of abnormal PoCUS findings from 151 patients with undifferentiated hypotension included left ventricular dynamic changes (43%), IVC abnormalities (27%), pericardial effusion (16%), and pleural fluid (8%). Abdominal pathology was rare (fluid 5%, AAA 2%). After two rounds of the survey, using majority consensus, agreement was reached on a SHoC-hypotension protocol comprising: A. Core: 1. Cardiac views (Sub-xiphoid and parasternal windows for pericardial fluid, cardiac form and ventricular function); 2. Lung views for pleural fluid and B-lines for filling status; and 3. IVC views for filling status; B. Supplementary: Additional cardiac views; and C. Additional views (when indicated) including peritoneal fluid, aorta, pelvic for IUP, and proximal leg veins for DVT. Conclusion: An international consensus process based on prospectively collected disease incidence has led to a proposed SHoC-hypotension PoCUS protocol comprising a stepwise clinical-indication based approach of Core, Supplementary and Additional PoCUS views.

scholarly journals Point-of-care Ultrasound Diagnosis of Pulmonary Embolism with Thrombus in Transit

2019 ◽  
Vol 3 (2) ◽  
pp. 11-12 ◽  
Author(s):  
Nicolas Kahl ◽  
Christopher Gabriel ◽  
Shadi Lahham ◽  
Maxwell Thompson ◽  
Wirachin Hoonpongsimanont
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Point Of Care ◽  
Skilled Nursing Facility ◽  
Point Of Care Ultrasound ◽  
Right Heart ◽  
Skilled Nursing ◽  
Chamber View ◽  
The Right ◽  
In Transit

A 95-year-old female with a history of dementia and atrial fibrillation (not on anticoagulation) presented to the emergency department (ED) by ambulance from her skilled nursing facility due to hypoxia. Point-of-care ultrasound was performed, and showed evidence of a large mobile thrombus in the right ventricle on apical four-chamber view. Further evidence of associated right heart strain was seen on the corresponding parasternal short-axis view. These ultrasound findings in combination with the patient’s clinical presentation are diagnostic of acute pulmonary embolism with right heart strain. Point-of-care transthoracic cardiac ultrasound in the ED is an effective tool to promptly diagnose acute pulmonary embolism with right heart strain and thrombus in transit and guide further treatment.

Internal medicine point-of-care ultrasound assessment of left ventricular function correlates with formal echocardiography

2015 ◽  
Vol 44 (2) ◽  
pp. 92-99 ◽  
Author(s):  
Benjamin K. Johnson ◽  
David M. Tierney ◽  
Terry K. Rosborough ◽  
Kevin M. Harris ◽  
Marc C. Newell
Keyword(s):  
Internal Medicine ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Point Of Care ◽  
Left Ventricular ◽  
Point Of Care Ultrasound ◽  
Ultrasound Assessment
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