Advertisement

Point-of-care echocardiography for aortic dissection, pulmonary embolism and acute coronary syndrome in patients with killer chest pain: EASY screening focused on the assessment of effusion, aorta, ventricular size and shape and ventricular asynergy

Abstract

Focus assessed transthoracic echocardiography and focused cardiac ultrasound are point-of-care echo protocols for the evaluation of cardiac disease in the emergency room; however, these protocols may not adequately assess aortic dissection, pulmonary embolism, and acute coronary syndrome in patients with killer chest pain. Here, I present an echocardiography protocol focused on screening for these critical cardiovascular diseases. This protocol (termed EASY screening) consists of the assessment of effusion in the pericardial space, aortic abnormalities, the size and shape of the ventricles and asynergy of the left ventricle. Aortic dissection is suggested by positive findings for effusion and/or abnormal aortic findings. Pulmonary embolism is suggested by a dilated right ventricle and a D-shaped left ventricle in the short-axis view. Acute coronary syndrome is suggested by asynergy of left ventricular wall motion. EASY screening may facilitate the assessment of aortic dissection, pulmonary embolism and acute coronary syndrome in patients presenting to the emergency room with killer chest pain.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Jensen MB, Sloth E, Larsen KM, et al. Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. Eur J Anaesthsiol. 2004;21:700–7.

  2. 2.

    Breitkreutz R, Walcher F, Seeger FH. Focused echocardiographic evaluation in resuscitation management: concept of an advanced life support-conformed algorithm. Crit Care Med. 2007;35:S150–61.

  3. 3.

    Via G, Hussain A, Wells M, et al. International evidence-based recommendations focused cardiac ultrasound. J Am Soc Echocardiogra. 2014;27(7):683.e1–33.

  4. 4.

    Gilon D, Mehta RH, Oh JK, et al. International Registry of Acute Aortic Dissection Group. Characteristics and in-hospital outcomes of patients with cardiac tamponade complicating type A acute aortic dissection. Am J Cardiol. 2009;103(7):1029–31.

  5. 5.

    Nishigami K. Simultaneous examination of the aorta in echocardiography of patients with coronary artery disease. J Echocardiogr. 2010;8:150–1.

  6. 6.

    Frémont B, Pacouret G, Jacobi D, et al. Prognostic value of echocardiographic right/left ventricular end-diastolic diameter ratio in patients with acute pulmonary embolism: results from a monocenter registry of 1,416 patients. Chest. 2008;133(2):358–62.

  7. 7.

    Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342(16):1163–70.

Download references

Author information

Correspondence to Kazuhiro Nishigami.

Ethics declarations

Conflict of interest

Kazuhiro Nishigami has received honoraria of $1,000 or less as a lecture fee from Astellas Pharma Inc., AstraZeneca K.K., Bayer Yakuhin Ltd., Boehringer Ingelheim Japan Inc., Kowa Pharmaceutical Co., Ltd., MSD K.K., Shionogi & Co., Ltd., Novartis Pharma K.K., Tanabemitsubishi Pharmaceutical Co., Ltd. and Takeda Pharmaceutical Co., Ltd.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 7 Movie 7: Parasternal short-axis view showing a straight interventricular septum and left ventricular deformity forming a D-shape (AVI 1369 kb)

Supplementary material 1 Movie 1: Transthoracic pulmonary echo showing the disappearance of lung sliding due to respiration (AVI 1412 kb)

Supplementary material 2 Movie 2: Left parasternal long-axis view showing effusion in the pericardial space (AVI 1268 kb)

Supplementary material 3 Movie 3: Left parasternal cardiovascular view on a small scale showing the long-axis view of the descending aorta and a flap (AVI 1149 kb)

Supplementary material 4 Movie 4: Left parasternal cardiovascular view from the superior intercostal showing the ascending aorta along with wall thickening (AVI 1192 kb)

Supplementary material 5 Movie 5: Parasternal cardiovascular view on a small scale showing the short-axis with crescent-shaped wall thickening (AVI 4670 kb)

Supplementary material 6 Movie 6: Parasternal long-axis view showing a dilated right ventricle. The diameter of the right ventricle is longer than that of the left ventricle (AVI 1317 kb)

Supplementary material 7 Movie 7: Parasternal short-axis view showing a straight interventricular septum and left ventricular deformity forming a D-shape (AVI 1369 kb)

Supplementary material 8 Movie 8: Apical long-axis view showing asynergy of the anteroseptal wall (AVI 2687 kb)

Supplementary material 9 Movie 9: Parasternal short-axis view showing asynergy of the basal inferior wall (AVI 3692 kb)

Supplementary material 10 Movie 10: Parasternal long-axis view showing asynergy of the posterior wall (AVI 3105 kb)

Supplementary material 11 Movie 11: Parasternal short-axis view showing extensive asynergy of the left ventricle, except for the inferior wall (AVI 669 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nishigami, K. Point-of-care echocardiography for aortic dissection, pulmonary embolism and acute coronary syndrome in patients with killer chest pain: EASY screening focused on the assessment of effusion, aorta, ventricular size and shape and ventricular asynergy. J Echocardiogr 13, 141–144 (2015). https://doi.org/10.1007/s12574-015-0265-1

Download citation

Keywords

  • Point-of-care echocardiography
  • Chest pain
  • Aortic dissection
  • Pulmonary embolism
  • Acute coronary syndrome