Echocardiography and emergency medicine

Susan F Dent, Robin Kikuchi, Lavanya Kondapalli, Roohi Ismail-Khan, Christine Brezden-Masley, Ana Barac, Michael Fradley
Advances in cancer screening and improved treatment approaches have led to an increase in survivorship and, consequently, recognition of an association between cancer treatments and the development of cardiovascular complications. In addition, as the population becomes proportionally older, comorbid cardiovascular risk factors are more prevalent in the population and compound the risk of developing cancer treatment-related cardiovascular toxicity. Cardio-oncology has emerged as a new subspecialty of medicine that provides a multidisciplinary approach, bringing together oncologists, cardiologists, and allied health care providers who are tasked with optimizing the cardiovascular health of patients exposed to potentially cardiotoxic cancer therapy...
March 2020: American Society of Clinical Oncology Educational Book
Yash Javeri, Ganshyam Jagathkar, Subhal Dixit, Dhruva Chaudhary, Kapil Gangadhar Zirpe, Yatin Mehta, Deepak Govil, Rajesh C Mishra, Srinivas Samavedam, Rahul Anil Pandit, Raymond Dominic Savio, Anuj M Clerk, Shrikanth Srinivasan, Deven Juneja, Sumit Ray, Tapas Kumar Sahoo, Srinivas Jakkinaboina, Nandhakishore Jampala, Ravi Jain
Background and Purpose: Short-term central venous catheterization (CVC) is one of the commonly used invasive interventions in ICU and other patient-care areas. Practice and management of CVC is not standardized, varies widely, and need appropriate guidance. Purpose of this document is to provide a comprehensive, evidence-based and up-to-date, one document source for practice and management of central venous catheterization. These recommendations are intended to be used by critical care physicians and allied professionals involved in care of patients with central venous lines...
January 2020: Indian Journal of Critical Care Medicine
C E Stiles, R P Steeds, W M Drake
The surveillance strategy for patients taking low dose cabergoline for hyperprolactinaemia is controversial. As more evidence has emerged that the risks of cardiac valvulopathy in this population of patients are low, fewer and fewer endocrinologists adhere strictly to the original medicines and healthcare products agency MHRA guidance of "at least" annual echocardiography. Strict adherence to this guidance would be costly in monetary terms (£5.76 million/year in the UK) and also in resource use (90,000 extra echocardiograms/year)...
February 28, 2020: Annales D'endocrinologie
Masataka Sugahara, Tohru Masuyama
The emergency room is a principal entrance for the initial management of patients with acute heart failure. Echocardiography may be performed by cardiologists and noncardiologists in the emergency room. Echocardiographic studies require effective technical skills and precise diagnostic knowledge. This article contributes to physicians in the emergency room, general practitioners in training, and medical staff who engage in emergency medicine. This article emphasized the role of echocardiography in light of pathophysiology of acute heart failure in the emergency room and refining the clinical workflow by integrating conventional and innovative knowledge for the initial management of acute heart failure...
April 2020: Heart Failure Clinics
Stacey Peters, Renee Johnson, Samuel Birch, Dominica Zentner, Ray E Hershberger, Diane Fatkin
Advances in human genome sequencing have re-invigorated genetics studies of dilated cardiomyopathy (DCM), facilitating genetic testing and clinical applications. With a range of genetic testing options now available, new challenges arise for data interpretation and identifying single pathogenic variants from the many thousands of rare variants present in every individual. There is accumulating evidence that genetic factors have an important role in the pathogenesis of DCM. However, although more than 100 genes have been implicated to date, the sensitivity of genetic testing, even in familial disease, is only ∼25-40%...
December 17, 2019: Heart, Lung & Circulation
Richard N Wang, Errel Khordipour
BACKGROUND: Direct current cardioversion is a common management option for termination of tachydysrhythmias, including atrial fibrillation and atrial flutter. It is generally safe and effective with infrequent reporting of side effects. Pulmonary edema is a rare complication with reported incidence of 1-3% and mortality of 18%. Our literature search did not reveal any reported cases of postcardioversion pulmonary edema in the emergency medicine literature. CASE REPORT: We report a case of an 80-year-old woman with a history of atypical atrial flutter on warfarin, paroxysmal atrial fibrillation, and rheumatic mitral valve disease who presented with shortness of breath 12 h after transesophageal echocardiography and subsequent direct current cardioversion with reversion to sinus rhythm...
January 20, 2020: Journal of Emergency Medicine
María Merino, Margarita Jiménez, Nicolás Manito, Emilio Casariego, Yoana Ivanova, Almudena González-Domínguez, Maite San Saturnino, Álvaro Hidalgo-Vega, Carles Blanch
AIMS: We aim to agree on a set of proposals to improve the current management of heart failure (HF) within the Spanish National Health System (SNHS) and apply the social return on investment (SROI) method to measure the social impact that these proposals would generate. METHODS AND RESULTS: A multidisciplinary working team of 16 experts was set up, with representation from the main stakeholders regarding HF: medical specialists (cardiologists, internal medicine physicians, general practitioners, and geriatric physicians), nursing professionals, health management professionals, patients, and informal caregivers...
January 9, 2020: ESC Heart Failure
Tara Lenk, John Whittle, Timothy E Miller, David G A Williams, Yuriy S Bronshteyn
Focused cardiac ultrasound (FoCUS)-a simplified, qualitative version of echocardiography-is a well-established tool in the armamentarium of critical care and emergency medicine. This review explores the extent to which FoCUS could also be used to enhance the preoperative physical examination to better utilise resources and identify those who would benefit most from detailed echocardiography prior to surgery. Among the range of pathologies that FoCUS can screen for, the conditions it provides the most utility in the preoperative setting are left ventricular systolic dysfunction (LVSD) and, in certain circumstances, significant aortic stenosis (AS)...
2019: Perioperative Medicine
F Saladini, C Mancusi, F Bertacchini, F Spannella, A Maloberti, A Giavarini, M Rosticci, R M Bruno, G Pucci, D Grassi, M Pengo, M L Muiesan
Hypertensive emergencies (HE) and urgencies (HU) are frequent causes of patients referral to Emergency Department (ED) and the approach may be different according to local clinical practice. Our aim was to explore awareness, management, treatment and counselling after discharge of HE and HU in Italy, by mean of an on-line survey. The young investigator research group of the Italian Society of Hypertension developed a 23-item questionnaire spread by e-mail invitation to the members of Italian Scientific societies in the field of Hypertension...
November 2, 2019: European Journal of Internal Medicine
Manjit Mahendran, Kartik Gupta, Arvind Kumar, Manasvini Bhatt, Maroof A Khan, Surabhi Vyas, Nayani Makkar, Upendra Baitha, Ranveer S Jadon, Naveet Wig
Context: Ultrasonography has become the frontline diagnostic tool for emergency care because of its non-invasive nature and the feasibility to perform repeated quick assessments in sick patients. The effectiveness of this modality, when used by trainee doctors to take clinically important decisions in patients requiring emergency care, is not much explored. In this pilot study, we analyzed whether use of this technology by Medicine resident doctors can help in better decision making in acutely and critical ill patients...
July 2019: Journal of Family Medicine and Primary Care
Anupam Dey, Vineetha Kanneganti, Debasish Das
Introduction: Subclinical hypothyroidism is defined as a serum TSH level above the upper limit of normal with normal levels of serum free thyroxine. It is a common thyroid disorder affecting 3-15% of the adult population. Aims and objectives: To study the cardiovascular profile of patients with subclinical hypothyroidism, and to establish cardiac risk factors emerging out of subclinical hypothyroidism. Methodology: Adult patients attending General Medicine department and diagnosed with subclinical hypothyroidism over a period of 2 months were enrolled...
July 2019: Journal of Family Medicine and Primary Care
Anne Bernard, Pascale Chemaly, Fanny Dion, Said Laribi, Francis Remerand, Denis Angoulvant, Fabrice Ivanes
BACKGROUND: Focus cardiac ultrasound is a great tool for quick evaluation of cardiac function in acute settings with limited time and expertise in echocardiography. Adequate training is essential for physicians willing to use this imaging technique. AIM: The goal of this study was to assess the efficacy of a self-training programme using a cardiac ultrasound simulator. METHODS: Thirty-five trainees in cardiology, emergency medicine or anaesthesiology entered the programme, which started with an e-learning lecture on focus cardiac ultrasound, with practice on a simulator, followed by implementation on patients, and ended with self-training in image analysis on an online platform...
July 23, 2019: Archives of Cardiovascular Diseases
Massimiliano Cantinotti, Martin Koestenberger, Giuseppe Santoro, Nadia Assanta, Eliana Franchi, Marco Paterni, Giorgio Iervasi, Antonello D'Andrea, Flavio D'Ascenzi, Raffaele Giordano, Maurizio Galderisi
In the last few years, multiple echocardiographic nomograms have been published. However, normal values calculated in the general population are not applicable to athletes, whose hearts may be enlarged and hypercontractile. Accordingly, athletes require specific nomograms. Our aim is to provide a critical review of echocardiographic nomograms on two-dimensional (2D) measures for athletes. We performed a systematic search in the National Library of Medicine for Medical Subject Headings and free text terms including echocardiography, athletes, normal values and nomograms ...
July 2, 2019: European Journal of Preventive Cardiology
Nora Celebi, Jan Griewatz, Nisar P Malek, Sarah Krieg, Toni Kuehnl, Reinhold Muller, Jan Pauluschke-Fröhlich, Ines Debove, Reimer Riessen, Stephan Zipfel, Eckhart Fröhlich
BACKGROUND: Ultrasound is one of the most important imaging techniques in clinical medicine with unique advantages. Skills in ultrasound imaging are very usefull for physicians including novices and thus also mandated by the Task Force "National Competence-Based Learning Objectives for Undergraduate Medical Education" (NKLM) in Germany and as well as by the German Ultrasound Society (Deutsche Gesellschaft für Ultraschall in der Medizin, DEGUM). Since ultrasound is best learned hands-on in very small supervised groups, we developed and implemented a comprehensive ultrasound-curriculum for all undergraduate medical students of our faculty using a peer-teaching concept...
May 28, 2019: BMC Medical Education
Andre Kumar, John Kugler, Trevor Jensen
Point-of-care ultrasonography (POCUS) has the potential to transform healthcare delivery through its diagnostic expediency. Trainee competency with POCUS is now mandated for emergency medicine through the Accreditation Council for Graduate Medical Education (ACGME), and its use is expanding into other medical specialties, including internal medicine. However, a key question remains: how does one define "competency" with this emerging technology? As our trainees become more acquainted with POCUS, it is vital to develop validated methodology for defining and measuring competency amongst inexperienced users...
June 2019: Journal of General Internal Medicine
F Knebel
A "biomarker" is measures something quantitatively or qualitatively, and this improves clinical decision-making. Echocardiography is therefore also a "biomarker". It provides information on anatomy, function and haemodynamics. Echocardiography can provide important information for almost all cardiovascular diseases in emergency and intensive care medicine: acute coronary syndrome, myocardial infarction, heart failure, pulmonary embolism, sepsis, endocarditis, stroke, etc. All patients with dyspnea, chest pain, respiratory insufficiency, sepsis and after resuscitation must receive echocardiography...
May 2019: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Christopher Kelly, Patrick Ockerse, Jason P Glotzbach, Rocky Jedick, Mark Carlberg, John Skaggs, David E Morgan
Cardiac arrest is a challenging clinical presentation that emergency medicine providers often encounter. Aortic dissection is an uncommon etiology in all-comers presenting in cardiac arrest. The use of bedside point of care echocardiography to aid in resuscitative efforts is expanding, particularly with the increasing use of transesophageal echocardiography (TEE) by emergency medicine providers. Additionally, emergency department initiation of extracorporeal membrane oxygenation (ECMO) is a relatively newer development in emergency department practice...
February 27, 2019: American Journal of Emergency Medicine
Jordan Chenkin, Edgar Hockmann, Tomislav Jelic
OBJECTIVES: Transesophageal echocardiography (TEE) is a relatively new resuscitation tool in the emergency department. Recent studies have demonstrated that it can impact diagnosis and management of critically ill patients. The objective of this study is to determine the effectiveness of a simulation-based curriculum for teaching emergency medicine residents a five-view TEE protocol. METHODS: Emergency medicine residents with previous ultrasound experience were invited to attend a 1-hour TEE training session...
July 2019: CJEM
Kevin Domingues, Mariana Saraiva, Liliana Marta, Isabel Monteiro, Margarida Leal
Cardiac amyloidosis is an infiltrative cardiomyopathy, resulting from amyloid deposition within the myocardium. In primary systemic (AL-type) amyloidosis, the amyloid protein is composed of light chains resulting from plasma-cell dyscrasia, and cardiac involvement occurs in up to 50% of the patients We present a case of a 43-year-old man, with complaints of periodical swollen tongue and xerostomia, bleeding gums and haematuria for two months. His blood results showed normocytic anaemia, thrombocytopenia and a high spontaneous INR, therefore he was referred to the Internal Medicine clinic...
September 2018: Revista da Associação Médica Brasileira
Inga Voges, Raffaele Giordano, Martin Koestenberg, Pietro Marchese, Marco Scalese, Lamia Ait-Ali, Giuseppe Santoro, Giorgio Iervasi, Israel Valverde, Shelby Kutty, Massimiliano Cantinotti
Our purpose is to provide an overview and to systematically review the strengths and limitations of studies on pediatric and adolescent normal values for cardiovascular MRI parameters. A literature search was performed within the National Library of Medicine using the following keywords: normal, reference values, cardiovascular magnetic resonance imaging, and children/pediatric. Eleven published studies evaluating cardiovascular MRI measurements in normal children were included in the present analysis. Our results revealed reasonable consistencies in the protocols employed for cardiovascular MRI...
January 7, 2019: Journal of Magnetic Resonance Imaging: JMRI
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