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bedside ultrasound heart failure

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June 2016: Annals of Intensive Care
Pilar Cubo-Romano, Juan Torres-Macho, Nilam J Soni, Luis F Reyes, Ana Rodríguez-Almodóvar, Juan Manuel Fernández-Alonso, Rosa González-Davia, José Manuel Casas-Rojo, Marcos I Restrepo, Gonzalo García de Casasola
BACKGROUND: Prognostication of patients hospitalized with acute decompensated heart failure (ADHF) is important to patients, providers, and healthcare systems. Few bedside tools exist to prognosticate patients hospitalized with ADHF. OBJECTIVE: The objective of this study was to assess the relationship between inferior vena cava (IVC) diameter and postdischarge mortality in patients hospitalized with ADHF. DESIGN: Prospective observational study...
June 6, 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Gurkeerat Singh, Bruce Sabath
An 84-year-old man with hypertension and a history of deep venous thrombosis (on warfarin) was admitted with shortness of breath presumed to be due to congestive heart failure. Echocardiogram performed the following day showed a low-normal ejection fraction with signs of elevated right-sided pressures but was otherwise normal. He improved with diuretic therapy but after a few days was found to be hypotensive with a concomitant rise in creatinine with decreased urine output. This was felt to be secondary to over-diuresis but he did not respond to small boluses of intravenous fluids as his kidney function continued to worsen and hypotension persisted...
2016: Journal of Community Hospital Internal Medicine Perspectives
Jennifer L Martindale, Abel Wakai, Sean P Collins, Phillip D Levy, Deborah Diercks, Brian C Hiestand, Gregory J Fermann, Ian deSouza, Richard Sinert
BACKGROUND: Acute heart failure (AHF) is one of the most common diagnoses assigned to emergency department (ED) patients who are hospitalized. Despite its high prevalence in the emergency setting, the diagnosis of AHF in ED patients with undifferentiated dyspnea can be challenging. OBJECTIVES: The primary objective of this study was to perform a systematic review and meta-analysis of the operating characteristics of diagnostic elements available to the emergency physician for diagnosing AHF...
March 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Federica Leidi, Francesco Casella, Chiara Cogliati
Dyspnea is a common presenting complaint in the emergency department (ED) and a leading cause of hospitalization in intensive care unit (ICU) and medical wards. Ultrasound (US) has traditionally been considered inadequate to explore the aerated lung. However, in the past 15 years LUS gained broader application, at least in part thanks to the interpretation of the artefacts generated by the interaction of US and lung structures/content. The total reflection of US beam occurring at the pleural level determines the artefactual image of the aerated lung: an homogenous 'foggy-like' picture under the pleural line...
June 2016: Internal and Emergency Medicine
Zhi-Peng Liu, Yu Zhang, Hong Bian, Xiao-Ran He, Ya-Jing Zhou, Li-Jun Wang, Ning Ding
BACKGROUND: We have found that there are usually 2 causes of acute dyspnea in our emergency department: (1) pulmonary infection only and (2) pulmonary infection in the setting of acute left ventricular heart failure (LVHF). These conditions are sometimes difficult to differentiate. Lung ultrasonography (LUS) is easily performed at the bedside and provides accurate information for diagnosis. In this study, we propose a simple B-line score to allow rapid differential diagnosis between these 2 lung conditions...
February 2016: American Journal of Emergency Medicine
William F Peacock, Chad M Cannon, Adam J Singer, Brian C Hiestand
The diagnosis of patients presenting to the emergency department with acute heart failure (AHF) is challenging due to the similarity of AHF symptoms to other conditions such as chronic obstructive pulmonary disease and pneumonia. Additionally, because AHF is most common in an older population, the presentation of coexistent pathologies further increases the challenge of making an accurate diagnosis and selecting the most appropriate treatment. Delays in the diagnosis and treatment of AHF can result in worse outcomes and higher healthcare costs...
2015: Critical Care: the Official Journal of the Critical Care Forum
Tanja Kaneko, Wolfgang Heinz
Despite the limitations (especially that ultrasound does not penetrate air containing lung tissue) ultrasound of the thorax is a very suitable method as a complementary or even primary diagnostic tool. Bedside availability and no radiation exposure are real advantages. However we always have to keep in mind that we are blind for deeper lung processes that do not have contact to the visceral pleura.This article illustrates where and how to look for pathologies and what we have to expect in patients. According to symptoms such as dyspnea, dyspnea with fever and thorax pain with and without trauma, the sonographic morphology of important illnesses in emergency situation are described...
November 2015: Deutsche Medizinische Wochenschrift
Narayan M Saha, Julian J Barbat, Savitri Fedson, Allen Anderson, Jonathan D Rich, Kirk T Spencer
Accurate assessment of volume status is critical in the management of patients with heart failure (HF). We studied the utility of a pocket-sized ultrasound device in an outpatient cardiology clinic as a tool to guide volume assessment. Inferior vena cava (IVC) size and collapsibility were assessed in 95 patients by residents briefly trained in focused cardiac ultrasound (FCU). Cardiologist assessment of volume status and changes in diuretic medication were also recorded. Patients were followed for occurrence of 30-day events...
October 15, 2015: American Journal of Cardiology
Michele Dalla Vestra, Elisabetta Grolla, Luca Bonanni, Vittorio Dorrucci, Fabio Presotto, Fausto Rigo
The presence of pulsating varicous veins is an uncommon finding, generically attributed to right heart failure. The precise causes of this phenomenon have been poorly defined in the literature. The finding of this infrequent condition is important because it may be a sign of major diseases, often not known. Here we described a 75-year-old woman presented to the Angiology Unit for the presence of bilateral pulsatile swelling in her groin and along both lower limbs. A bedside ultrasound examination showed an arterial like pulsating flow both in the superficial and in the deep veins of the lower limbs due to a severe tricuspid regurgitation not previously known...
2015: Case Reports in Vascular Medicine
Daniel A Lichtenstein
This review article describes two protocols adapted from lung ultrasound: the bedside lung ultrasound in emergency (BLUE)-protocol for the immediate diagnosis of acute respiratory failure and the fluid administration limited by lung sonography (FALLS)-protocol for the management of acute circulatory failure. These applications require the mastery of 10 signs indicating normal lung surface (bat sign, lung sliding, A-lines), pleural effusions (quad and sinusoid sign), lung consolidations (fractal and tissue-like sign), interstitial syndrome (lung rockets), and pneumothorax (stratosphere sign and the lung point)...
June 2015: Chest
Alan T Chiem, Connie H Chan, Douglas S Ander, Andrew N Kobylivker, William C Manson
OBJECTIVES: The goal of this study was to examine the ability of emergency physicians who are not experts in emergency ultrasound (US) to perform lung ultrasonography and to identify B-lines. The hypothesis was that novice sonographers are able to perform lung US and identify B-lines after a brief intervention. In addition, the authors examined the diagnostic accuracy of B-lines in undifferentiated dyspneic patients for the diagnosis of acute heart failure syndrome (AHFS), using an eight-lung-zone technique as well as an abbreviated two-lung-zone technique...
May 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
André Denault, Yoan Lamarche, Antoine Rochon, Jennifer Cogan, Mark Liszkowski, Jean-Sébastien Lebon, Christian Ayoub, Jean Taillefer, Robert Blain, Claudia Viens, Pierre Couture, Alain Deschamps
Perioperative care for cardiac surgery is undergoing rapid evolution. Many of the changes involve the application of novel technologies to tackle common challenges in optimizing perioperative management. Herein, we illustrate recent advances in perioperative management by focusing on a number of novel components that we judge to be particularly important. These include: the introduction of brain and somatic oximetry; transesophageal echocardiographic hemodynamic monitoring and bedside focused ultrasound; ultrasound-guided vascular access; point-of-care coagulation surveillance; right ventricular pressure monitoring; novel inhaled treatment for right ventricular failure; new approaches for postoperative pain management; novel approaches in specialized care procedures to ensure quality control; and specific approaches to optimize the management for postoperative cardiac arrest...
December 2014: Canadian Journal of Cardiology
Fabrizio Ricci, Roberta Aquilani, Francesco Radico, Francesco Bianco, Gioacchino Giuseppe Dipace, Ester Miniero, Raffaele De Caterina, Sabina Gallina
Lung ultrasonography is an emerging, user-friendly and easy-to-use technique that can be performed quickly at the patient's bedside to evaluate several pathologic conditions affecting the lung. Ultrasound lung comets (ULCs) are an echographic sign of uncertain biophysical characterisation mostly attributed to water-thickened subpleural interlobular septa, but invariably associated with increased extravascular lung water. ULCs have thus been proposed as a complementary tool for the assessment and monitoring of acute heart failure and are now entering into statements in international recommendation documents...
April 2015: European Heart Journal. Acute Cardiovascular Care
Matej Strnad, Gregor Prosen, Vesna Borovnik Lesjak
OBJECTIVE: The aim of this pilot study was to determine the usefulness of prehospital lung ultrasound in monitoring the effectiveness of treatment with continuous positive airway pressure (CPAP) versus standard therapy in patients with acute decompensated heart failure (ADHF). MATERIALS AND METHODS: Twenty patients with ADHF were enrolled in this prospective, observational study. They were allocated randomly to a CPAP group (CPAP and standard therapy) or a control group (standard therapy only)...
February 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Luciano Cardinale, Adriano Massimiliano Priola, Federica Moretti, Giovanni Volpicelli
Hydrostatic pulmonary edema is as an abnormal increase in extravascular water secondary to elevated pressure in the pulmonary circulation, due to congestive heart failure or intravascular volume overload. Diagnosis of hydrostatic pulmonary edema is usually based on clinical signs associated to conventional radiography findings. Interpretation of radiologic signs of cardiogenic pulmonary edema are often questionable and subject. For a bedside prompt evaluation, lung ultrasound (LUS) may assess pulmonary congestion through the evaluation of vertical reverberation artifacts, known as B-lines...
June 28, 2014: World Journal of Radiology
Daniele G Biasucci, Zaccaria Ricci, Giorgio Conti, Paola Cogo
INTRODUCTION: Performed for many years in clinical settings, pleural and lung ultrasound (PLUS) has emerged to be an invaluable tool to diagnose underlying conditions of respiratory failure, to monitor disease progression and to ensure appropriate therapeutic intervention. PLUS basically relies on the analysis of two prevalent ultrasound artefacts: A-lines and B-lines. A-lines are hyperechoic reverberation artefacts of the pleural line. A-lines combined with lung sliding show that lungs are well aerated...
December 2014: Pediatric Pulmonology
Ellie P Salinski, Charles C Worrilow
BACKGROUND: Diagnosed ST-segment elevation myocardial infarction (STEMI) usually prompts rapid cardiac catheterization response. OBJECTIVE: Our aim was to raise awareness that hypothermia can cause electrocardiographic (ECG) changes that mimic STEMI. CASE REPORT: Emergency Medical Services (EMS) was called for altered mental status and lethargy in a 47-year-old man with a medical history of paraplegia. His history included hepatitis C, hypertension, seizures, anxiety, and recent pneumonia treated with i...
April 2014: Journal of Emergency Medicine
Gregory R Lisciandro, Geoffrey T Fosgate, Robert M Fulton
Lung ultrasound is superior to lung auscultation and supine chest radiography for many respiratory conditions in human patients. Ultrasound diagnoses are based on easily learned patterns of sonographic findings and artifacts in standardized images. By applying the wet lung (ultrasound lung rockets or B-lines, representing interstitial edema) versus dry lung (A-lines with a glide sign) concept many respiratory conditions can be diagnosed or excluded. The ultrasound probe can be used as a visual stethoscope for the evaluation of human lungs because dry artifacts (A-lines with a glide sign) predominate over wet artifacts (ultrasound lung rockets or B-lines)...
May 2014: Veterinary Radiology & Ultrasound
Amer M Johri, Walid Barake, Bredon Crawford, Gulisa Turashvili, John Rossiter, Gerald A Evans
A case of fulminant myocarditis in a young man is described. Bedside hand-held focused cardiac ultrasound demonstrated severe systolic dysfunction with hypertrophied myocardium. Echocardiogram showed a speckled texture of the myocardium and a "velvet-like" appearance. Unfortunately, the patient developed cardiogenic shock and despite aggressive management, he died. The autopsy showed multifocal lymphohistiocytic infiltration and myocyte injury. We propose that the "velvet" myocardial ultrasonic appearance with ventricular hypertrophy is an indicator of rapid clinical demise...
December 2013: Canadian Journal of Cardiology
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