Echocardiography

"Emergency Echocardiography" by Anthony Weekes provides a comprehensive overview of the role of echocardiography in emergency medicine. The book focuses on the application of bedside ultrasound to quickly assess and diagnose various cardiac conditions, such as heart failure, cardiac tamponade, and pulmonary embolism, in critically ill patients. It emphasizes the importance of rapid, non-invasive imaging in making timely clinical decisions and improving patient outcomes in emergency settings.

This article examines the prognostic value of echocardiography performed by emergency physicians in patients with acute pulmonary thromboembolism (PE). It highlights how bedside echocardiography can assess right ventricular dysfunction, which is a key determinant of outcomes in PE patients. The study demonstrates that early identification of right heart strain using echocardiography can guide risk stratification and inform treatment decisions, ultimately improving patient management and prognosis in the emergency department.

This article discusses the significance of pulmonary hypertension (PH) and right ventricular (RV) failure in emergency medicine, emphasizing their critical role in the management of acutely ill patients. It explores the pathophysiology of PH and RV failure, highlighting how these conditions can lead to poor outcomes if not promptly recognized and treated. The article also outlines the diagnostic tools, such as echocardiography and point-of-care ultrasound, that are essential for assessing RV function and pulmonary pressures in the emergency department, enabling timely intervention to improve patient prognosis.

This article evaluates the use of the E-point to septal separation (EPSS) method for quantitatively estimating left ventricular ejection fraction (LVEF) and compares it to the gold standard of magnetic resonance imaging (MRI). The study finds that EPSS, a simple and non-invasive echocardiographic measurement, can accurately estimate LVEF, offering a practical alternative for assessing heart function, particularly in settings where MRI is not available. The results suggest that EPSS provides a reliable correlation with MRI, making it a valuable tool for routine cardiac assessments in clinical practice.

This article evaluates the diagnostic accuracy of various markers of right ventricular dysfunction (RVD) in normotensive emergency department patients with acute pulmonary embolism (PE). It investigates how markers such as right ventricular dilation, tricuspid regurgitation velocity, and the right ventricle/left ventricle ratio can help identify RVD in patients without hypotension, a group that is often underdiagnosed. The study highlights the importance of using these markers to stratify risk and guide management in normotensive PE patients, as early detection of RVD can improve outcomes.

The WAMAMI study demonstrates that emergency physicians can accurately identify wall motion abnormalities (WMAs) in patients with acute myocardial infarction (AMI) using point-of-care ultrasound. The study shows that with proper training, emergency physicians can detect these abnormalities with a high degree of sensitivity and specificity, similar to traditional imaging methods like echocardiography or MRI. This capability enhances early diagnosis and decision-making in the management of AMI, ultimately improving patient outcomes in the emergency department.

This article discusses the rationale for using the velocity-time integral (VTI) and the minute distance as tools to assess stroke volume and cardiac output in point-of-care settings. The velocity-time integral, which measures the area under the velocity curve of blood flow, allows for accurate determination of stroke volume when combined with other echocardiographic measurements. The minute distance, calculated as the product of stroke volume and heart rate, provides a simple method for evaluating cardiac output, making these metrics particularly useful in emergency and critical care environments where rapid, non-invasive assessments are crucial for patient management.

This article discusses the usefulness of emergency ultrasound in non-traumatic cardiac arrest, highlighting its role in identifying reversible causes of arrest, such as cardiac tamponade, pulmonary embolism, or hypovolemia. Ultrasound provides real-time visualization of the heart, allowing for quicker diagnosis and targeted interventions, potentially improving outcomes in critical cases. The study emphasizes that, when used appropriately, emergency ultrasound can complement traditional resuscitation efforts by aiding in decision-making without significantly delaying chest compressions or other life-saving procedures.

This article explores the concept of the overloaded right heart and ventricular interdependence, focusing on how right ventricular dysfunction can influence left ventricular function and overall cardiac performance. When the right heart is overloaded due to conditions such as pulmonary hypertension or acute pulmonary embolism, it can lead to changes in the interventricular septum, which in turn affects left ventricular filling and output. The study highlights the importance of understanding these interrelationships for accurate diagnosis and management of conditions affecting both ventricles, particularly in critical care settings.

This article examines the accuracy of visual estimation of left ventricular ejection fraction (LVEF) by emergency physicians using bedside echocardiography. The study found that emergency physicians could reliably estimate LVEF with good agreement to more objective measurements, such as those obtained through advanced imaging techniques. Visual estimation of LVEF can be a valuable tool in emergency settings for rapid decision-making and management of patients with acute cardiac conditions, especially when time is critical.

This article introduces a novel parasternal approach to ultrasound-guided pericardiocentesis, a procedure used to drain fluid from the pericardial sac in cases of pericardial effusion. The parasternal approach offers several advantages, including improved accuracy, reduced risk of complications, and easier visualization of the pericardial space, especially in patients with challenging anatomy. The study highlights the effectiveness of this technique in providing safer and more efficient pericardiocentesis in both emergency and critical care settings.

This article explores the current and future applications of ultrasound in anesthesia practice. It highlights how ultrasound has revolutionized the field by improving the accuracy and safety of procedures such as regional anesthesia, central venous access, and airway management. Looking ahead, the article discusses the potential for expanded use of ultrasound in anesthesiology, including point-of-care imaging for real-time assessment of patients, and the increasing role of advanced techniques in enhancing anesthetic care and training.

This article discusses how the use of ultrasound during cardiopulmonary resuscitation (CPR) can lead to delays in chest compressions, potentially compromising the quality of resuscitation efforts. While ultrasound provides valuable real-time diagnostic information, such as identifying reversible causes of cardiac arrest, its use may interrupt the continuity of chest compressions, which are critical for maintaining circulation. The article emphasizes the need for careful integration of ultrasound into CPR protocols to balance diagnostic benefit with the importance of maintaining high-quality chest compressions.

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This article reviews the current state of echocardiography in diagnosing and managing infective endocarditis (IE). Echocardiography, particularly transesophageal echocardiography (TEE), is crucial in detecting valvular vegetation, assessing valve function, and identifying complications like abscesses or embolic events. The review highlights advances in echocardiographic techniques, which have improved the sensitivity and specificity of IE diagnosis, and underscores the importance of early and accurate imaging to guide treatment decisions and improve patient outcomes.

This retrospective study, part of the REASON study, investigates the role of bedside ultrasound in managing pulseless electrical activity (PEA) during resuscitation. The study found that ultrasound can help identify specific interventions, such as the detection of reversible causes like cardiac tamponade or hypovolemia, which are associated with improved survival rates to hospital admission. The findings emphasize the potential of ultrasound to guide timely and effective interventions, ultimately enhancing patient outcomes in cases of PEA.

This study explores the use of pulsed and continuous wave Doppler echocardiography to assess valvular regurgitation in normal subjects. It demonstrates that Doppler techniques can detect very mild degrees of regurgitation in healthy individuals, suggesting that small amounts of regurgitation might be common in normal hearts. The findings highlight the importance of interpreting Doppler echocardiographic results carefully, as even minimal regurgitation in healthy subjects may not necessarily indicate pathology.

This article discusses the advancements in imaging techniques that have improved the understanding of diastolic dysfunction, a condition where the heart's ventricles struggle to relax and fill with blood. Techniques such as cardiac MRI, tissue Doppler imaging, and phase-contrast MRI have provided more detailed insights into myocardial strain, tissue properties, and blood flow patterns. These emerging imaging methods are crucial for more accurate diagnosis, identifying underlying causes, and guiding treatment for patients with diastolic dysfunction.

Right heart thrombus in transit is a critical condition where a thrombus moves through the right heart chambers, posing a high risk of pulmonary embolism and sudden death. Echocardiography is essential for diagnosis, enabling differentiation between thrombi originating from atrial fibrillation and those from deep venous thrombosis. Management strategies vary, including surgical embolectomy and catheter-based interventions, tailored to the patient's condition.

This study compares the use of transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) during cardiopulmonary resuscitation (CPR) and finds that TEE is associated with shorter compression pauses. The results suggest that TEE, due to its more direct access to the heart, allows for quicker and more efficient assessment, reducing interruptions in chest compressions. The study highlights the potential of TEE to improve the quality of CPR by minimizing delays and enhancing real-time decision-making during resuscitation efforts.

This study examines the interobserver reliability of echocardiography in prognosticating normotensive patients with pulmonary embolism (PE). It found that echocardiographic findings, such as right ventricular dysfunction, are consistently reproducible across different observers, making it a reliable tool for risk stratification in these patients. The results highlight the value of echocardiography in assessing PE severity and guiding clinical decision-making, even in patients who remain normotensive.

In syncope patients with a normal initial evaluation, including history, physical exam, and ECG, transthoracic echocardiography (TTE) generally has a low diagnostic yield. Studies show it rarely identifies significant cardiac pathology in the absence of clinical red flags. Therefore, TTE is recommended primarily for patients with abnormal findings or a high suspicion of structural heart disease.

This study focuses on evaluating right ventricular (RV) systolic function in patients with acute pulmonary embolism (PE) by analyzing tricuspid annular motion (TAM). It found that TAM, measured using echocardiography, is a reliable and accessible method to assess RV function in PE patients, with impaired motion correlating to more severe outcomes. The study suggests that TAM analysis can be a valuable tool in the emergency department for the early detection of RV dysfunction in PE cases.

In the 2012 article "Thoracic Ultrasound," Dr. Joel P. Turner and Dr. Jerrald Dankoff discuss the principles and applications of thoracic ultrasound in emergency medicine. They emphasize its utility in diagnosing conditions such as pneumothorax, pleural effusion, pneumonia, and pulmonary edema. The authors highlight that lung ultrasound can achieve sensitivity levels comparable to computed tomography (CT) scans for many indications, making it an essential tool for emergency physicians assessing patients with respiratory complaints.

This study evaluates the feasibility and clinical impact of focused transesophageal echocardiography (f-TEE) performed by emergency physicians as part of a novel ultrasound program. The findings show that f-TEE is both technically feasible and provides clinically valuable information, improving patient management in emergency settings. It concludes that emergency physicians can successfully incorporate f-TEE into clinical practice, leading to faster diagnoses and more informed treatment decisions.

This study explores the use of emergency echocardiography to detect pericardial effusion in patients experiencing pulseless electrical activity (PEA) and near-PEA states. It emphasizes that rapid echocardiographic evaluation can identify pericardial effusion as a reversible cause of PEA, enabling timely pericardiocentesis and improving patient outcomes. The findings suggest that integrating echocardiography into the emergency management of PEA can be crucial for diagnosing and treating life-threatening conditions efficiently.

This study demonstrates that point-of-care ultrasonography (POCUS) in the emergency department significantly improves the time to perform pericardiocentesis in patients with clinically significant pericardial effusions. By enabling rapid identification and assessment of effusions at the bedside, POCUS facilitates timely intervention, reducing the delay in relieving tamponade symptoms. The findings highlight the value of POCUS in enhancing the efficiency and outcomes of emergency care for patients with pericardial effusion.

This study explores the differentiation between stress (Takotsubo) cardiomyopathy and acute coronary syndrome (ACS) using clinical risk factors and coronary evaluation in real-world clinical settings. It emphasizes that Takotsubo cardiomyopathy often presents similarly to ACS but can be distinguished by coronary imaging, which typically shows no significant blockages in Takotsubo patients. The findings suggest that understanding patient history, risk factors, and the results of coronary evaluation are key in accurately diagnosing these conditions.

This case highlights a hypertensive patient who presents with abdominal fullness, which is an unusual symptom for cardiac tamponade. The diagnosis was made through clinical examination and imaging, revealing the presence of fluid in the pericardial sac, compressing the heart and affecting its function. The case underscores the importance of considering cardiac tamponade in hypertensive patients with atypical symptoms, as early recognition and intervention are critical for preventing complications.

Evaluating the aortic arch via the suprasternal notch view (SSNV) using focused cardiac ultrasound (FOCUS) is a valuable technique for assessing thoracic aortic pathology, such as aneurysms and dissections. This approach allows emergency physicians to obtain real-time images of the aortic arch, facilitating prompt diagnosis and management.

The American Society of Echocardiography (ASE) has announced a call for papers for a focus issue on chamber quantification, scheduled for publication in early 2026, with submissions due by June 1, 2025. Additionally, ASE is preparing to celebrate its 50th anniversary in September 2025 in Nashville, introducing initiatives like the "ASE Goes Green" campaign to reduce environmental impact. The November issue of the Journal of the American Society of Echocardiography (JASE) features a state-of-the-art review on advances in assessing patients with tricuspid regurgitation, highlighting the echocardiographic evaluation before and after tricuspid valve interventions.

Incorporating echocardiography into stress electrocardiography (ECG) enhances the evaluation of chest pain patients in the emergency department (ED). Stress echocardiography (SE) provides superior diagnostic accuracy compared to stress ECG alone, particularly in detecting significant coronary artery disease (CAD). Studies have demonstrated that SE is feasible and safe for early stratification of patients presenting with acute chest pain and non-ischemic ECGs, facilitating timely and appropriate management decisions.

Incorporating stress echocardiography (SE) into an acute chest pain service is both feasible and effective for rapidly assessing and triaging patients with suspected acute coronary syndrome (ACS) who present with non-diagnostic electrocardiograms (ECGs) and negative 12-hour troponin levels. Studies have demonstrated that SE provides accurate risk stratification in this patient population, facilitating early discharge and appropriate management decisions.

In patients presenting with chest pain in the emergency department (ED), the diagnostic yield of ST-segment elevation myocardial infarction (STEMI) amplitude criteria is notably low. A comprehensive study involving 19,932 patients found that conventional ECG criteria for STEMI were met in only 502 cases, corresponding to a sensitivity of 17%, specificity of 98%, and positive predictive value (PPV) of 12%. When extended ECG criteria were applied, sensitivity increased to 30%, specificity decreased to 94%, and PPV remained low at 8%. Incorporating reciprocal ST depression into the criteria modestly improved the PPV to 24% for conventional and 23% for extended criteria.

Point-of-care ultrasound (POCUS) is a valuable tool for evaluating pericardial effusions and assessing for cardiac tamponade at the bedside. By performing focused echocardiography, clinicians can quickly identify the presence of pericardial effusion and determine if tamponade physiology is present, which requires urgent evaluation and management.

In acutely dyspneic patients, junior emergency physicians (EPs) can effectively use E-point septal separation (EPSS) measurements to estimate left ventricular ejection fraction (LVEF). A study involving 58 patients demonstrated a strong correlation between EPSS measurements taken by junior EPs and visual LVEF estimates by senior EPs and cardiologists (ρ = -0.844, p < 0.001).

Stent migration into the right ventricle is a rare but serious complication following endovenous stenting in patients with nutcracker syndrome. In a reported case, a stent migrated into the right ventricle five months after placement, leading to significant tricuspid regurgitation and necessitating prosthetic valve replacement.

In patients with high-risk inferior myocardial infarction (MI), assessing right ventricular (RV) involvement is crucial, as it can influence prognosis and guide management. Speckle tracking echocardiography, particularly measuring RV free wall longitudinal strain (FWLS), has emerged as a valuable tool for this purpose.

In patients experiencing their first acute anterior myocardial infarction (AAMI), the presence of ST segment depression in the inferior leads of the electrocardiogram (ECG) serves as a significant prognostic indicator. A study involving 206 such patients treated with primary percutaneous coronary intervention (PPCI) found that the sum of ST segment depression amplitude in the inferior leads upon admission was independently associated with in-hospital mortality. Specifically, patients in the highest tertile of ST segment depression exhibited a 5.7-fold increased risk of in-hospital death compared to those in the lowest tertile.

SCAD is a complex and often underdiagnosed condition that requires a high index of suspicion, especially in young women presenting with acute coronary syndrome symptoms. Advancements in imaging techniques have improved diagnostic accuracy, and ongoing research is essential to better understand its pathophysiology and optimize management strategies.

"The Sound of Silence" is an editorial by Dr. Shannon Moffett, published in the Annals of Emergency Medicine in February 2018. In this piece, Dr. Moffett discusses the challenges emergency physicians face when interpreting cardiac standstill during point-of-care ultrasound (POCUS). He emphasizes the variability in physician assessments of cardiac activity and the critical importance of accurate interpretation in guiding patient management.

The study "Identification of Echocardiographic 'Smoke' in a Bench Model with Transcranial Doppler Ultrasound" investigates the nature of spontaneous echo contrast (SEC), commonly known as "smoke," observed in cardiac chambers. Researchers recreated SEC in an in vitro model under low-flow conditions and examined its characteristics using two-dimensional echocardiography and transcranial Doppler ultrasound. The findings indicate that while SEC is a distinct echocardiographic phenomenon occurring at low flow rates, it does not produce embolic material capable of entering the systemic circulation.

Spontaneous echo contrast (SEC), often referred to as "smoke," is characterized by dynamic, smoke-like echoes within the left atrium (LA) or appendage, typically observed during transesophageal echocardiography (TEE). This phenomenon is commonly associated with conditions such as atrial arrhythmias, mitral stenosis, or the presence of a mitral valve prosthesis, all of which can lead to LA enlargement and stasis. Conversely, mitral regurgitation is generally protective against the development of LA SEC.

Point-of-care echocardiography (POCE) enables pediatric emergency physicians (PEM) to rapidly assess cardiac function at the bedside, facilitating timely diagnosis and management. Studies have demonstrated that with goal-directed training, PEM physicians can accurately evaluate left ventricular (LV) systolic function, vascular filling, and pericardial effusion. For instance, a study involving 70 patients found that PEM physicians achieved a sensitivity of 95% and specificity of 83% in detecting significant LV systolic dysfunction, vascular filling, and pericardial effusion compared to formal echocardiograms.

The article "Pathophysiology of Right Ventricular Failure in Acute Pulmonary Embolism and Chronic Thromboembolic Pulmonary Hypertension: A Pictorial Essay for the Interventional Radiologist" by Yolanda C. Bryce and colleagues provides an in-depth exploration of the mechanisms leading to right ventricular (RV) failure in these conditions. The authors emphasize that acute massive and submassive pulmonary embolism (PE), along with chronic thromboembolic pulmonary hypertension (CTEPH), significantly increase pulmonary vascular resistance, thereby elevating RV afterload. This heightened afterload can severely impair RV function, potentially resulting in hemodynamic collapse and death. Understanding these pathophysiological processes is crucial for interventional radiologists, as it underpins the rationale for therapeutic interventions aimed at reducing RV afterload and improving patient outcomes.

The study "Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs" highlights the utility of focused cardiac ultrasound (FOCUS) in evaluating emergency department (ED) patients with suspected pulmonary embolism (PE) and abnormal vital signs. The research indicates that a negative FOCUS examination can significantly reduce the likelihood of a PE diagnosis, particularly in patients with a heart rate of 110 beats per minute or higher. This suggests that FOCUS is a valuable tool in the initial assessment of such patients.

In obstructive hypertrophic cardiomyopathy (HOCM), the mitral valve plays a crucial role in left ventricular outflow tract (LVOT) obstruction. Anatomic abnormalities of the mitral valve, such as elongated anterior mitral valve leaflets and abnormal papillary muscle positioning, are common in HOCM patients and contribute to systolic anterior motion (SAM) of the mitral valve, leading to LVOT obstruction. Understanding these mitral valve abnormalities is essential for diagnosing and managing HOCM, as they significantly impact the severity of LVOT obstruction and associated symptoms.

In the article "Septal Bounce" by Christopher M. Walker and colleagues, published in the Journal of Thoracic Imaging in January 2012, the authors discuss the phenomenon of septal bounce—a paradoxical movement of the interventricular septum during early diastole. This motion is characterized by the septum initially moving toward and then away from the left ventricle. Septal bounce is considered a specific and relatively sensitive sign of ventricular interdependence due to constrictive pericarditis and is considered a reliable sign to distinguish constrictive pericarditis from restrictive cardiomyopathy.

In the study "Accuracy of Emergency Physicians for Detection of Regional Wall Motion Abnormalities in Patients With Chest Pain Without ST-Elevation Myocardial Infarction," emergency physicians trained in bedside echocardiography demonstrated high sensitivity (94%) and specificity (35%) for detecting regional wall motion abnormalities (RWMAs) in patients presenting with chest pain and suspected non-ST-elevation myocardial infarction (NSTEMI). The study concluded that emergency physicians with appropriate training can accurately identify patients with RWMAs, aiding in the timely diagnosis and management of NSTEMI.

The study "Bedside assessment of central venous pressure by sonographic measurement of right ventricular outflow-tract fractional shortening" by Ünlüer et al. investigates the use of right ventricular outflow tract (RVOT) fractional shortening as a non-invasive method to estimate central venous pressure (CVP). The researchers found that a cutoff value of 26.44% for RVOT fractional shortening effectively differentiated low from normal CVP, with a sensitivity of 95% and specificity of 80%. This suggests that RVOT fractional shortening can be a reliable tool for emergency physicians to assess CVP at the bedside.

In the study "Diagnostic Accuracy of Right Ventricular Dysfunction Markers in Normotensive Emergency Department Patients With Acute Pulmonary Embolism," goal-directed echocardiography demonstrated high sensitivity (100%) and specificity (99%) for identifying severe right ventricular (RV) dysfunction in normotensive patients with acute pulmonary embolism (PE). Brain natriuretic peptide (BNP) showed good sensitivity (88%) but lower specificity (68%), while troponin had higher specificity (93%) but lower sensitivity (62%). Computed tomography (CT) also effectively identified RV dysfunction with a sensitivity of 91% and specificity of 79%.

Following a sub-massive pulmonary embolism (PE), patients may experience persistent right ventricular dysfunction (RVD) and pulmonary hypertension (PHT). A study by Samaranayake et al. found that 58.6% of patients exhibited RVD and 40.2% had PHT upon admission. While many patients show improvement over time, a subset continues to have elevated right ventricular systolic pressures, indicating the need for ongoing monitoring and management.

In the 2010 article "The Echocardiographic Assessment of the Right Ventricle: What to Do in 2010?" by Ruxandra Jurcut and colleagues, the authors review various echocardiographic techniques for evaluating right ventricular (RV) function. They discuss parameters such as myocardial velocity and strain rate imaging, highlighting their potential in assessing RV function. The article emphasizes the need for further validation studies to establish the clinical utility of these novel echocardiographic methods.

The right ventricle (RV) is particularly vulnerable to increased afterload, as seen in acute pulmonary embolism (PE), where sudden obstruction elevates pulmonary artery pressure, leading to RV dilation and dysfunction. In chronic PE, persistent obstruction and elevated pressures cause RV hypertrophy and eventual failure. Echocardiographic assessment is crucial in both scenarios to evaluate RV size, function, and pressure estimates, aiding in diagnosis and management.

In the article "What are the echocardiographic findings of acute right ventricular strain that suggest pulmonary embolism?" by Stephen Alerhand, the author reviews ten echocardiographic indicators of right ventricular (RV) strain associated with pulmonary embolism (PE). These findings include: increased right ventricle to left ventricle size ratio, abnormal septal motion, McConnell's sign, tricuspid regurgitation, elevated pulmonary artery systolic pressure, decreased tricuspid annular plane systolic excursion (TAPSE), decreased S' wave velocity, pulmonary artery mid-systolic notching, the 60/60 sign, and speckle tracking showing reduced RV free wall strain. Recognizing these echocardiographic signs can aid in the timely diagnosis and management of PE.

This article reviews the role of point-of-care ultrasound (POCUS) during cardiopulmonary resuscitation (CPR), emphasizing its utility in guiding real-time clinical decisions. POCUS helps identify reversible causes of cardiac arrest, such as cardiac tamponade, pulmonary embolism, or hypovolemia, while assessing cardiac activity and response to resuscitation efforts. The review highlights the need for proper integration of POCUS into resuscitation protocols to enhance outcomes without delaying critical life-saving interventions.

Acute right ventricular (RV) strain on echocardiography suggesting pulmonary embolism includes RV dilation with an increased RV/LV ratio (>0.9-1.0) and septal flattening or paradoxical motion, creating a "D-shaped" left ventricle. Additional findings include McConnell's sign (mid-RV free wall akinesia with apical sparing), elevated tricuspid regurgitant velocity indicating pulmonary hypertension, and a dilated, non-collapsible inferior vena cava (IVC). These findings, while indicative of RV pressure overload, should be confirmed with further imaging like CT pulmonary angiography for a definitive diagnosis.

This article explores the utility of contrast echocardiography in the emergency department (ED) for diagnosing various cardiovascular conditions. Contrast agents improve the visibility of cardiac structures, enabling better assessment of left ventricular function, myocardial perfusion, and the detection of conditions such as cardiac tamponade, heart failure, and pulmonary embolism. The article highlights how contrast echocardiography can enhance diagnostic accuracy in emergency settings, providing valuable information for timely treatment decisions.

This article provides an update on the use of bedside ultrasound for diagnosing pericardial effusion, emphasizing its importance as a rapid and reliable tool in acute care settings. Bedside ultrasound can detect the presence, size, and hemodynamic impact of pericardial effusion, aiding in the early identification of cardiac tamponade. The update highlights advancements in imaging techniques, best practices for interpretation, and the integration of ultrasound into clinical protocols to improve patient outcomes.

This article reviews the use of systemic thrombolysis in the treatment of pulmonary embolism (PE), particularly for patients with high-risk or massive PE. Thrombolytic therapy aims to rapidly dissolve the clot, restoring pulmonary blood flow and preventing hemodynamic collapse, which is crucial in severe cases of PE. The review discusses the benefits, risks, and clinical guidelines surrounding systemic thrombolysis, highlighting its role in improving outcomes for patients with life-threatening PE, while also considering potential complications such as bleeding.

This article evaluates an artificial intelligence (AI)-powered electrocardiogram (ECG) model designed to detect acute coronary occlusion myocardial infarction (ACO-MI). The AI model analyzes ECG patterns with high sensitivity and specificity, outperforming traditional diagnostic methods in identifying ACO-MI, which requires urgent intervention. The study highlights the potential of integrating AI technology into clinical practice to improve early detection, accelerate treatment, and enhance outcomes for patients with ACO-MI.

This article provides recommendations from the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association on the use of echocardiography in acute cardiovascular care. It emphasizes the role of echocardiography in diagnosing and managing conditions like acute heart failure, myocardial infarction, and acute pulmonary embolism, offering real-time, non-invasive insights into cardiac function. The guidelines suggest that echocardiography should be integrated into emergency and intensive care settings to enhance decision-making, improve patient outcomes, and guide therapy in critically ill cardiovascular patients.

Pulsus paradoxus is an exaggerated decrease in systolic blood pressure (more than 10 mmHg) during inspiration, which can be detected clinically or via monitoring. It occurs due to increased intrathoracic pressure, which impairs venous return to the left heart, reducing stroke volume and cardiac output. Common causes include cardiac tamponade, severe asthma, chronic obstructive pulmonary disease (COPD), and, less commonly, pulmonary embolism.

This article examines acute major pulmonary embolism (PE) as a cause of exaggerated respiratory blood pressure variation and pulsus paradoxus. These phenomena occur due to increased intrathoracic pressure swings and impaired right ventricular filling caused by the embolism, leading to a marked drop in systolic blood pressure during inspiration. Recognizing these signs can aid in the early diagnosis of severe PE, prompting timely intervention to improve patient outcomes.

This article reviews pulmonary valve stenosis (PVS) in adult patients, focusing on its pathophysiology, diagnosis, and treatment. PVS, often congenital in origin, leads to increased right ventricular pressure and hypertrophy, potentially causing fatigue, dyspnea, and arrhythmias. Diagnosis is typically made with echocardiography, while management ranges from periodic monitoring for mild cases to balloon valvuloplasty or surgical intervention in severe cases to alleviate obstruction and improve symptoms.

This article examines the predissection aortic size in patients with acute type A aortic dissection and finds that over 90% of cases do not meet current guideline criteria for elective ascending aortic replacement. Many dissections occur in patients with aortic diameters below the recommended threshold for preventive surgery, suggesting that current guidelines may not adequately predict risk. The study highlights the need for revised criteria that better identify high-risk individuals, potentially improving early intervention and reducing the incidence of acute dissections.

This article examines the use of pre-hospital transthoracic echocardiography (TTE) to identify non-ST-elevation myocardial infarction (NSTEMI) in patients experiencing acute coronary syndrome (ACS). By providing early imaging of the heart, pre-hospital TTE can help detect regional wall motion abnormalities indicative of NSTEMI before patients reach the hospital. This early identification allows for faster decision-making and initiation of treatment, potentially improving outcomes in ACS patients without classic ST-elevation on an ECG.

This article discusses the use of Doppler echocardiography to noninvasively estimate pulmonary vascular resistance (PVR) in patients with chronic heart failure. Doppler-derived measures of flow velocities and pressure gradients across the pulmonary circulation provide accurate assessments of PVR, a key parameter in evaluating right heart strain and pulmonary hypertension. By offering a reliable alternative to invasive catheterization, this method facilitates early diagnosis and management of pulmonary vascular complications in heart failure patients.

This article explores the use of Tricuspid Annular Plane Systolic Excursion (TAPSE) as a tool for risk stratification and prognostication in patients with pulmonary embolism (PE). TAPSE, a measure of right ventricular systolic function on echocardiography, helps identify patients at higher risk of adverse outcomes due to right ventricular strain from PE. By integrating TAPSE into clinical evaluations, healthcare providers can better assess the severity of PE and guide treatment decisions to improve patient outcomes.

The prognosis in cardiac arrest depends on timely intervention, with factors like rapid defibrillation, effective CPR, and achieving return of spontaneous circulation (ROSC) improving outcomes. Favorable long-term recovery also requires minimizing brain injury through post-resuscitation care, including targeted temperature management. Delayed treatment or prolonged periods without blood flow significantly reduce survival and neurologic recovery chances.

This article discusses how identifying cardiac movement through prehospital echocardiography can help predict outcomes in patients experiencing cardiac arrest. The presence of cardiac activity on ultrasound in the field is associated with a higher likelihood of return of spontaneous circulation (ROSC) and improved survival rates. Using echocardiography as a rapid assessment tool in prehospital settings aids in making informed decisions about resuscitation efforts and transport, potentially enhancing patient outcomes in cardiac arrest cases.

This article explores the use of athlete-focused echocardiograms to assess cardiac health and determine sports eligibility, particularly for detecting conditions that could pose risks during intense physical activity. The echocardiogram is tailored to identify specific cardiac adaptations or abnormalities commonly seen in athletes, such as left ventricular hypertrophy or arrhythmias, which might otherwise be overlooked in standard exams. This targeted approach aims to enhance safety in sports participation by providing more accurate assessments of an athlete’s heart health and identifying those at risk for sudden cardiac events.

This article discusses the use of point-of-care ultrasound (POCUS) to diagnose cardiac tamponade by identifying "flow velocity paradoxus." This finding refers to exaggerated respiratory variations in ventricular inflow velocities, which are indicative of impaired cardiac filling due to high pericardial pressure. The article highlights the effectiveness of POCUS in quickly detecting this flow pattern, allowing for timely diagnosis and intervention in cases of suspected cardiac tamponade.

"Point-of-Care Ultrasound" by Linda Lee describes the use of bedside ultrasound as a quick diagnostic tool for real-time assessment in various clinical settings. The article explains how POCUS can identify a range of conditions, including cardiac, lung, and abdominal issues, directly at the patient’s side, reducing the need for formal imaging and expediting care. Lee emphasizes POCUS’s impact on improving diagnostic efficiency and enhancing patient outcomes, particularly in emergency and critical care environments.

This article examines the benefits of integrating point-of-care ultrasound (POCUS) into emergency department evaluations for patients presenting with chest pain and shortness of breath. POCUS aids in rapidly identifying underlying causes such as heart failure, pericardial effusion, pulmonary embolism, or pneumothorax, which may not be immediately clear from initial examinations. By providing real-time diagnostic insights, POCUS helps expedite appropriate treatment, ultimately improving patient outcomes in acute care settings.

This article evaluates the effectiveness of McConnell's Sign—right ventricular free wall hypokinesis with apical sparing—as a diagnostic indicator for acute pulmonary embolism (PE) on transthoracic echocardiography. Findings suggest that McConnell's Sign has a poor positive predictive value for PE, meaning it may not reliably confirm the diagnosis on its own. The article underscores the need for additional diagnostic tests to accurately diagnose PE, as relying solely on McConnell's Sign may lead to misdiagnosis or delayed treatment.

This article highlights that point-of-care ultrasonography (POCUS) in the emergency department significantly reduces the time to perform pericardiocentesis in patients with clinically significant pericardial effusions. POCUS enables rapid, bedside visualization of the effusion, allowing for quicker diagnosis and precise needle guidance during the procedure. By streamlining the diagnostic and treatment process, POCUS helps improve patient outcomes in emergency settings where timely intervention is critical.

This article argues that physical fitness alone is not a reliable predictor of acute coronary syndromes (ACS) in emergency department (ED) patients presenting with chest pain. Despite generally being healthier, physically fit individuals can still experience ACS due to underlying risk factors like plaque rupture or genetic predispositions. The study emphasizes the need for comprehensive assessments, including risk factors and diagnostic testing, rather than relying on fitness levels to assess ACS risk in chest pain cases.

Echocardiographic signs that indicate pericardial effusion is causing tamponade include right atrial and right ventricular collapse, which occur due to increased pericardial pressure compressing these chambers. Additionally, exaggerated respiratory variations in mitral and tricuspid valve flow velocities signal impaired heart filling. A dilated inferior vena cava with minimal inspiratory collapse further suggests elevated pressures and restricted cardiac filling, confirming tamponade physiology.

This article investigates the relationship between pericardial fat volume and the severity of coronary artery disease (CAD) in patients with preserved ejection fraction. The findings suggest that increased pericardial fat volume is an independent risk factor for more severe CAD, likely due to its role in local inflammation and vascular effects. Identifying and measuring pericardial fat could therefore aid in risk assessment and inform preventive strategies for CAD in patients with otherwise normal heart function.

This article examines advancements in the diagnosis and treatment of pericardial effusion and cardiac tamponade in recent years. Modern imaging techniques, such as echocardiography, have improved detection and assessment of pericardial fluid, enhancing timely diagnosis and management. The article highlights new treatment approaches, including echo-guided pericardiocentesis and individualized care strategies, which have increased the safety and effectiveness of managing these potentially life-threatening conditions.

This article explores the phenomenon of pseudo cardiac tamponade, where excess pericardial fat can mimic the appearance of cardiac tamponade on imaging. In these cases, the fat accumulation around the heart creates a similar visual effect to pericardial effusion, potentially leading to misdiagnosis. The study emphasizes the importance of distinguishing between true tamponade and pseudo tamponade to avoid unnecessary interventions and ensure accurate patient care.

The ELOPE prospective cohort study investigates the functional and exercise limitations that persist after a first episode of pulmonary embolism (PE). The study found that many patients experience reduced exercise capacity and functional impairment even after the acute event has resolved, with limitations affecting daily activities and quality of life. These findings highlight the need for long-term rehabilitation and monitoring to address residual effects and improve outcomes for PE survivors.

This article discusses the complications arising from fractures and migration of inferior vena cava (IVC) stents, which can lead to multiple heart injuries. Stent fractures and migration can cause mechanical damage to the heart, including perforations, arrhythmias, or obstruction of blood flow, posing significant risks to patient health. The article emphasizes the importance of monitoring IVC stent placement and function to prevent such severe complications and improve patient outcomes.

This article presents a structured and simplified teaching tool designed to improve the evaluation and management of pulseless electrical activity (PEA), a cardiac arrest rhythm without effective blood flow. The tool organizes key steps and considerations, helping healthcare providers quickly identify and address reversible causes of PEA, such as hypoxia, hypovolemia, and electrolyte imbalances. By streamlining the approach, this tool aims to enhance provider confidence and response efficiency, potentially improving patient outcomes in emergency situations.

This article focuses on the role of diagnostic imaging in assessing patients with acute pulmonary embolism (PE) and its importance in risk stratification. Imaging techniques, such as computed tomography pulmonary angiography (CTPA) and echocardiography, help determine the size and location of the embolism, as well as assess right ventricular function, which is critical for guiding treatment decisions. Proper risk stratification using these imaging tools helps identify high-risk patients who may require more aggressive interventions, ultimately improving clinical outcomes.

The article on the pathophysiology of heart failure explains that heart failure occurs when the heart cannot pump blood effectively, often due to conditions like hypertension or ischemic heart disease. Key mechanisms include impaired myocardial contractility, increased ventricular stiffness, and the activation of compensatory neurohormonal systems, such as the sympathetic nervous system and renin-angiotensin-aldosterone system. Over time, these compensatory mechanisms worsen the condition by increasing fluid retention, preload, and afterload, leading to the symptoms of heart failure.

This meta-analysis investigates whether pericardial effusion is a negative prognostic marker by reviewing its association with clinical outcomes. The findings suggest that pericardial effusion, particularly when associated with factors like right ventricular compression or larger volumes, is linked to worse outcomes, including higher mortality rates. However, the prognosis varies depending on the underlying cause, with some patients having favorable outcomes if managed appropriately.

Viral myocarditis is an inflammatory heart condition often triggered by viral infections, which can damage heart muscle cells and lead to symptoms ranging from mild fatigue to severe heart failure. Diagnosis involves clinical evaluation, imaging, and sometimes biopsies to detect inflammation and assess heart function. Treatment generally includes managing symptoms, supporting heart function, and sometimes antiviral or immunosuppressive therapies, though approaches vary depending on the severity and underlying virus.

This article discusses the formation of right atrial thrombus, or blood clots, as a complication secondary to pacemaker wires, which are used to regulate heart rhythms. The presence of pacemaker leads in the heart can disrupt normal blood flow, potentially leading to thrombus formation, which may increase the risk of embolism or other cardiovascular events. The article emphasizes the importance of monitoring patients with pacemakers for signs of thrombus and the need for timely intervention to prevent serious complications.

This article explores the use of echocardiography-guided pericardiocentesis in patients with clinically significant pericardial effusion, a condition where excess fluid accumulates in the pericardial sac, potentially compromising heart function. Echocardiography provides real-time imaging, allowing for precise needle placement and reducing the risk of complications during the procedure. The study highlights the effectiveness and safety of echo-guided pericardiocentesis, particularly in emergency and critical care settings, ensuring accurate fluid removal while minimizing procedural risks.

This article examines the use of bedside echocardiography by emergency physicians to quickly assess cardiac function in critical situations. Bedside echocardiography allows for rapid, point-of-care evaluation of heart conditions, such as pericardial effusion, heart failure, and wall motion abnormalities, directly impacting treatment decisions. The practice is increasingly recognized as a vital tool in emergency medicine, providing timely and accurate information that can improve patient outcomes in urgent care settings.

This article investigates the short-term clinical outcomes of patients with acute pulmonary embolism (PE) who present with normal blood pressure but show right ventricular dysfunction on echocardiography. Despite normal blood pressure, right ventricular dysfunction in these patients is associated with increased risk of complications, making it a critical factor in assessing severity and guiding treatment decisions. The findings underscore the importance of echocardiographic evaluation for risk stratification in PE cases, even when traditional signs of instability, like hypotension, are absent.

This article evaluates the effectiveness of point-of-care ultrasonography (POCUS) for detecting cardiac pathology when performed by novice examiners, comparing it to traditional, gold-standard imaging methods. Findings suggest that with proper training, novice operators can achieve accuracy levels similar to those of expert-performed echocardiography, making POCUS a valuable tool in early diagnosis and management. This supports the role of POCUS as a feasible, efficient, and accessible method for cardiac assessment in various healthcare settings.

This article discusses the potential of point-of-care ultrasound (POCUS) to accelerate the diagnosis and treatment of occult occlusive myocardial infarction (OMI), a type of heart attack that may not immediately show on standard tests. By providing real-time imaging, POCUS helps identify wall motion abnormalities or other signs of myocardial infarction, facilitating quicker decision-making and timely revascularization. The technique is especially valuable in emergency settings, potentially improving outcomes by addressing OMI before severe complications arise.

This article explores the use of fibrinolysis, or clot-dissolving therapy, for patients with intermediate-risk pulmonary embolism (PE), a condition where blood clots obstruct the pulmonary arteries and compromise lung and heart function. Fibrinolysis can improve outcomes in patients with moderate PE risk, though it carries bleeding risks, making careful patient selection crucial. The article discusses balancing benefits and risks to optimize treatment for intermediate-risk PE patients, potentially preventing escalation to severe complications.

This article discusses a new in-plane approach for ultrasound-guided pericardiocentesis, a procedure used to drain fluid from the pericardium, the sac surrounding the heart. The in-plane technique improves visualization of the needle path in real time, enhancing the precision and safety of the procedure. This method aims to reduce complications associated with pericardiocentesis by providing clearer guidance for clinicians during needle insertion.

This article examines the use of bedside ultrasonography by emergency physicians in diagnosing heart failure due to dilated cardiomyopathy, a condition where the heart becomes weakened and enlarged, impairing its ability to pump blood effectively. Bedside ultrasound enables rapid, non-invasive assessment of cardiac function, allowing for quicker identification of heart failure symptoms and immediate management decisions. This approach enhances diagnostic accuracy and can expedite critical care for patients presenting with symptoms of heart failure in emergency settings.

Myocardial, perivascular, and epicardial fat are different types of fat deposits in and around the heart, each with distinct roles and health implications. Epicardial fat lies around the heart, while perivascular fat surrounds blood vessels, and myocardial fat infiltrates the heart muscle itself. Excessive accumulation of these fats is associated with cardiovascular risks, including inflammation, coronary artery disease, and metabolic disorders, making them important indicators in heart health assessments and potential targets for preventive care.

This article evaluates the effectiveness of the biplane modified Simpson's method for estimating pericardial effusion volume and compares it to the actual volume obtained through pericardiocentesis. The study demonstrates that this echocardiographic technique provides accurate estimations of effusion volume, making it a reliable non-invasive alternative for assessment. By establishing a correlation between echocardiographic measurements and pericardiocentesis findings, the research supports the use of this method in clinical practice for better management of patients with pericardial effusion.