scholarly journals Unusual cause of heart failure in the young, the intracardiac mass: Diagnostic dilemmas solved by echocardiography

2021 ◽  
pp. 201010582110112
Author(s):  
Kelvin Shenq Woei Siew ◽  
Kim Fong Ng ◽  
Norliza Othman ◽  
Chuey Yan Lee
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Cardiac Failure ◽  
Cardiac Tumor ◽  
Point Of Care ◽  
Cardiac Tumors ◽  
Point Of Care Ultrasound ◽  
Delay In Diagnosis ◽  
Coronary Syndrome

Primary cardiac tumor remains exceedingly rare, accounting for 0.5 cases per million of the population annually. We report a case of cardiac tumor, which was initially misdiagnosed as heart failure secondary to acute coronary syndrome. The diagnosis was revised later after routine echocardiography in the ward. A 39-year-old gentleman who presented to the emergency department with cardiac failure and ischemic changes on the electrocardiogram was initially worked-up for acute coronary syndrome. However, echocardiography was performed later in the ward to evaluate the cardiac ejection fraction, revealing a massive left atrial mass measuring 6 cm × 4 cm. Severe mitral regurgitation was noted through the echocardiogram owing to the mass prolapse into the mitral annulus. The initial presentation of cardiac tumors can be ambiguous. Studies have shown that echocardiography as the noninvasive cardiac imaging approach remains the gold standard of diagnostic tool. Hence, echocardiography should be performed as a routine assessment of cardiac failure. Meanwhile, the incorporation of point of care ultrasound in the available center may assist the physician to diagnose accurately in the emergency department setting by excluding other potential differential diagnoses. Delay in diagnosis and initiation of treatment may result in progression to chronic heart failure and dangerous complication, i.e. hemodynamic sequelae and systemic embolism of the clot. In our experience, we managed to reach an accurate diagnosis, timely referral and appropriate intervention despite the lack of point of care ultrasound.

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 Results From an Early Economic Evaluation of the Use of a Novel Point of Care Device for Diagnosis of Suspected Acute Coronary Syndrome Patient Within the Emergency Department in the National Health Service in England.

2021 ◽  
Author(s):  
Mamta Kumari Bajre ◽  
Adrian Towse ◽  
Andrew Stainthorpe ◽  
Julie Hart
Keyword(s):  
Emergency Department ◽  
Sensitivity Analysis ◽  
Acute Coronary Syndrome ◽  
Economic Evaluation ◽  
Point Of Care ◽  
Acute Coronary Syndrome Patient ◽  
Turnaround Time ◽  
Standard Laboratory ◽  
Coronary Syndrome ◽  
Diagnostic Pathway

Abstract Background: The objective of this study was to undertake an early economic evaluation to analyse the potential costs and benefits associated with adopting a high sensitivity troponin (hs-cTn) at the Point of Care (POC) in the emergency department (ED) diagnostic pathway for suspected Acute Coronary Syndrome (ACS) patients in line with National Institute for Health and Care Excellence (NICE) Diagnostics Guidance (DG15) and NICE Clinical Guideline (CG95) as practised in the NHS in England. Methods: A decision tree analysis was undertaken to compare the current 60 to 90 minutes turnaround time for the standard laboratory hs-cTn test with an expected 20-minute turnaround time for a POC hs-cTn test. Three routes through the chest pain pathway were modelled based on the hs-cTn pathway used in Oxford University Hospitals (OUH) NHS Foundation Trust. Sensitivity analysis was performed. Results: The results indicate that if a hs-cTn POC test is used to diagnose patients in routes 1 to 3 of the diagnostic pathway for suspected ACS patients at ED, it potentially saves per patient costs of £53.36 in Route 1, £76.72 in Route 2 and £64.72 in Route 3. Moreover, it can also help in easing the pressure at ED as it enables diagnosis to be made between 55 to 70 minutes earlier across the 3 pathway routes. A hs-cTn POC test also has potential in achieving a ‘rule-in’ diagnosis for patients to speed up the treatment pathway for improved prognosis. The sensitivity analysis results indicate that savings per patient increase as the turnaround time of the lab result goes from 60 minutes to 90 minutes in the standard care pathway.Conclusions: Use of a hs-cTn test at POC can save between £53.36 and £76.72 per patient in ED when compared to the standard laboratory test. When such a POC test is developed, an evaluation validating the accuracy of the device will be needed together with a study of its clinical performance in a health care setting. The study should include a formal economic evaluation with real-world data alongside an efficacy/effectiveness study.

scholarly journals URGENT 1.5: diagnostic accuracy of the modified HEART score, with fingerstick point-of-care troponin testing, in ruling out acute coronary syndrome

2021 ◽  
Author(s):  
L. H. Koper ◽  
L. D. S. Frenk ◽  
J. G. Meeder ◽  
F. H. M. van Osch ◽  
A. L. Bruinen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Diagnostic Accuracy ◽  
Point Of Care ◽  
Hospital Setting ◽  
Total Study Population ◽  
Heart Score ◽  
Coronary Syndrome ◽  
Cardiac Emergency

Abstract Background The HEART score is a validated risk stratification tool for chest pain patients presenting to the emergency department and was recently investigated for implementation in a pre-hospital setting. Fingerstick (capillary blood) point-of-care (POC) troponin testing enables quick measurements outside the hospital and seems easier to implement than the current venous blood sampling techniques. This study investigates the diagnostic accuracy of the modified HEART score, integrating fingerstick POC troponin testing, in ruling out acute coronary syndrome (ACS). Methods The data of 96 patients with chest pain, included in a study investigating a novel POC troponin device under development at the cardiac emergency department, were analysed retrospectively. Based on the patients’ admission data and capillary POC high-sensitivity troponin I (hs-cTnI) results, the modified HEART score was determined. The outcome measure, for evaluating the diagnostic accuracy of the modified HEART score, was the occurrence of ACS. Results Of the total study population, 33 patients (34%) were diagnosed with ACS. Seventeen patients (18%) were classified as low risk (0–3 points) and one patient (6%) in this group was diagnosed with ACS. The sensitivity and negative predictive value of the modified HEART score was 97.0 and 97.6%, respectively. Conclusion The modified HEART score, integrating capillary POC hs-cTnI results, is a promising tool for ruling out ACS in patients with chest pain presenting to the cardiac emergency department. These results encourage prospective investigation into the integration of fingerstick POC troponin testing in the modified HEART score in a pre-hospital setting.

scholarly journals LO074: Point of care ultrasound for lung B-lines in the early diagnosis of acute decompensated heart failure in the emergency department: a systematic review

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S55-S55
Author(s):  
K. McGivery ◽  
P.R. Atkinson ◽  
D. Lewis ◽  
L. Taylor ◽  
K. Gadd
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Emergency Department ◽  
Likelihood Ratio ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Point Of Care ◽  
Decompensated Heart Failure ◽  
Point Of Care Ultrasound ◽  
B Lines

Introduction: Dyspnea is a common presenting problem in the emergency department (ED) that frequently creates a diagnostic challenge for physicians. Acute decompensated heart failure (ADHF) represents a common cause that requires prompt diagnosis and management. Recent studies on dyspneic patients have suggested a potential role for point-of-care ultrasound (PoCUS). The objective of this systematic review was to assess the sensitivity and specificity of early bedside lung ultrasound in patients presenting to the ED with dyspnea. Methods: A search of the literature was conducted using PubMed, EMBASE, the Cochrane Library, bibliographies of previous systematic reviews, and abstracts from major emergency medicine conferences. We included prospective studies that assessed the diagnostic accuracy of B-lines from bedside lung ultrasound in the ED patients compared to a clinical diagnosis of ADHF at hospital discharge. The final diagnosis included at least one of CXR, computed tomography, or BNP. Two reviewers independently screened all titles and abstracts for possible inclusions. Two separate content experts full text-reviewed selected studies and performed quality analysis using a modified Critical Appraisal Skills Program (CASP) questionnaire. Extracted data was assessed with summary receiver operator characteristics curve (SROC) analysis with pooled sensitivity and specificity. Heterogenity was tested. Results: The electronic search yielded 3674 articles of which six met the inclusion criteria and fulfilled CASP requirements for methodological quality. The total number of patients in these studies was 1911. Heterogeneity was noted; due to poorer performance by novice users. Meta-analysis of the data showed that in detecting ADHF, bedside lung ultrasound had a pooled sensitivity of 89.6% (95% CI 69.5 to 97.0%) and a pooled specificity of 88.4% (95% CI 75.0 to 95.1%). The positive likelihood ratio was 6.01 (95% CI 2.93 to 12.32) and negative likelihood ratio was 0.13 (95% CI 0.06 to 0.30). Conclusion: This study suggests that in patients presenting to the ED with undifferentiated dyspnea, early point of care lung ultrasound may be used to confirm the diagnosis of ADHF, which may facilitate earlier appropriate management. Test performance may vary according to experience.

Point-of-care troponin testing and management of patients with acute coronary syndrome: a systematic review

2020 ◽  
Vol 15 (2) ◽  
pp. 1-16
Author(s):  
Huiyun Du ◽  
So Ting Chan ◽  
Parichat Wonggom ◽  
Peter Newman ◽  
Rosy Tirimacco ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Cardiac Troponin ◽  
Point Of Care ◽  
Clinical Care ◽  
Grey Literature ◽  
Rapid Test ◽  
Point Of Care Testing ◽  
Coronary Syndrome

Background Early identification of acute coronary syndrome is crucial for a patient's likelihood of survival. Point-of-care testing of cardiac troponin is a rapid test of cardiac troponin that can be conducted closer to where clinical care is delivered, with a significant shorter turnaround time. Point-of-care testing of troponin may improve timely diagnosis of acute coronary syndrome. Aim To examine existing evidence on the effectiveness of point-of-care testing of troponin for acute coronary syndrome management in the emergency department. Methods A systematic review of randomised controlled trials was conducted across databases, and grey literature. Results No study evaluated adherence to acute coronary syndrome management guidelines. One of the five studies that assessed length of stay showed a statistically significant reduction (P=0.035). Two of the three studies that measured time to disposition in emergency department demonstrated statistically significant effects (P=0.04 vs P=0.05) favouring point-of-care testing of troponin. One study demonstrated statistically significant effects on successful discharge to home from emergency department (P=0.001). No significant effects were reported for mortality or accuracy. Conclusion Point-of-care testing of troponin can significantly reduce time to disposition in emergency department and successful discharge home. Translation of this evidence into clinical practice is recommended.

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