Point-of-care ultrasound diagnosis of acute valvular emergencies

Abstract

Introduction: Acute valvular emergencies, a time-sensitive diagnosis, are nearly impossible to diagnose without ultrasound, and missing the diagnosis can significantly impact patient outcomes. Many emergency physicians lack access to echo technicians and may be uncomfortable performing the ultrasound themselves. Approaching the paucity of review articles, none of which are focused for the emergency physician, can be quite daunting, even for those with extensive ultrasound training.

Objective: Our goal is to provide a simple resource for emergency physicians to utilize ultrasound to diagnose acute valvular emergencies. We created a concise review that includes relevance and approach to the diagnosis, complete with live ultrasound images, reference cards, and focused figures for in-the-moment reference.

Methods: A team of ultrasound fellowship-trained emergency medicine physicians determined the highest yield emergent conditions and oversaw the project. Each team member reviewed the etiology, incidence, and level of evidentiary support for each condition and then provided a guide to the appropriate procedure and evaluation with relevant additional guidance. An in-house graphics team was consulted to prepare original, concise figures for easy reference. All sections of the manuscript and figures were reviewed for accuracy and ease of use.

Discussion: Critical aortic stenosis, infective endocarditis, left ventricular outflow tract obstruction, mitral stenosis, and mitral regurgitation were identified diagnoses for which ultrasound can provide immediate diagnostic information for emergency physicians.

Conclusion: The use of ultrasound in the emergency department setting is a critical adjunct to care for patients with acute valvular emergencies. One should always consider a comprehensive, cardiology-performed echocardiogram in these scenarios.

Keywords: Acute valvular emergency; Critical aortic stenosis; Infective endocarditis; Left ventricular outflow tract obstruction; Mitral regurgitation; Mitral stenosis; Point-of-care ultrasound.