Point-of-Care Ultrasound for the Diagnosis of Systolic Heart Failure

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.

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

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.5.47012 ◽

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.

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

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.3.45002 ◽

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.

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

Case Reports in Emergency Medicine ◽

10.1155/2018/2859676 ◽

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.

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

Cardiorenal Medicine ◽

10.1159/000511714 ◽

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

Introduction: 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. Objective: The aim of this study is to evaluate PVF alterations in patients with ADHF at arrival and after decongestive treatment. Methods: 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). Results: 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. Conclusions: Evaluation of abdominal venous congestion by point-of-care ultrasound could aid in diagnosis and follow-up of patients with congestive kidney injury.

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Case report: an unrecognized etiology of transient gallbladder pain in heart failure diagnosed with internist-performed point-of-care ultrasound

Critical Ultrasound Journal ◽

10.1186/s13089-014-0019-8 ◽

2015 ◽

Vol 7 (1) ◽

Cited By ~ 5

Author(s):

Christine N Desautels ◽

David M Tierney ◽

Federico Rossi ◽

Terry K Rosborough

Keyword(s):

Heart Failure ◽

Case Report ◽

Point Of Care ◽

Point Of Care Ultrasound

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The heart and resuscitation

Point of Care Ultrasound for Emergency Medicine and Resuscitation ◽

10.1093/med/9780198777540.003.0002 ◽

2019 ◽

pp. 33-70

Author(s):

Tim Harris ◽

Matthew Wong ◽

James French ◽

Sharon Kay ◽

Paul Atkinson

Keyword(s):

Heart Failure ◽

Acute Care ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

The Core ◽

Core Skills ◽

Detailed Assessment ◽

Focused Echocardiography ◽

Real Time Information ◽

Time Information

Focused echocardiography and point-of-care ultrasound are becoming core skills for doctors working in acute care and arguably a key skill set for those with an interest in resuscitation medicine. Echo is the most useful test now available to define the aetiology of shock and to guide fluid/cardiac resuscitation. This chapter aims to teach the core and intermediate skills required to perform echo as non-cardiologists. These skills do not replace the need for a cardiology opinion or a detailed assessment by a trained sonographer or cardiologist, but simply enable those caring for patients to obtain key real-time information as rapidly as possible. The chapter’s focus is not on comprehensive assessment, but on rapidly identifying the causes of shock and acute heart failure and guiding therapy. The emphasis is therefore different from that found in dedicated textbooks on echocardiography written for trainees in cardiology and is at a simpler level.

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P0304POINT OF CARE ULTRASOUND IN NEPHROLOGY: THE SOONER THE BETTER!

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0304 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Mirela Liana Gliga ◽

Mihail Gheorghe Gliga ◽

Cristian Chirila ◽

Raluca-Maria Lie-Ungurean ◽

Paula Chirila

Keyword(s):

Heart Failure ◽

Renal Failure ◽

Ct Scan ◽

Point Of Care ◽

Vena Cava ◽

Decompensated Heart Failure ◽

Portable Device ◽

Diagnostic Tools ◽

Point Of Care Ultrasound ◽

Linear Probe

Abstract Background and Aims Point of care ultrasound (POCUS) is performed at the bedsite of the patient by de treating clinician. In nephrology a particular situation is related to severly ill patients, immobilized with elevated creatinine, which can not be deffered to imaging investigations such as CT scan or MRI. Using a small portable device, important clinical problems can be solved in no time. Method We examined 360 out of 670 patients admitted to the nephrology departament in a period of one year. They were severely ill due to following pathologies: 35 severe sepsis with hypotension, 53 decompensated heart failure, 24 stroke, 248 with renal failure and acido-basic or electrolitic disturbances. Evaluation was made using a portable US device with a 10 MHz linear probe and 3.5 MHz convexe probe with abdomen and thoracic software. Diameter of inferior vena cava (IVC), respiratory collapse of IVC, effusions in pleura, pericardium or peritoneum, liver dimensions, kidneys and spleen were described. Results 31 out of 35 patients with hypotension had collapsed IVC, diameter less than 1cm, PPV 88.5%; 48 from 53 heart failure had enlarged IVC with reduced respiratory collapse, PPV 90.6% and 201 from 248 renal failure patients had kidney changes, 81.04%. As compared with standard diagnostic tools (echocardiography, native CT scan and clinical examination, Sensitivity was over 98% in all cases. Conclusion POCUS is a very usefull test for the rapid bed-site examination of kidney patients, were a rapid decision has to be made using a portable device. Sensitivity of the method proved to be comparable as with standard diagnostic tools.

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