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Introduction Cardiac point‐of‐care ultrasound (c‐POCUS) is an increasingly implemented diagnostic tool with the potential to guide clinical management. We sought to characterize and analyze the existing c‐POCUS literature with a focus on the temporal trends and differences across specialties. Methods A literature search for c‐POCUS and related terms was conducted using Ovid (MEDLINE and Embase) and Web of Science databases through 2020. Eligible publications were classified by publication type and topic, author specialty, geographical region of senior author, and journal specialty. Results The initial search produced 1761 potential publications. A strict definition of c‐POCUS yielded a final total of 574 cardiac POCUS manuscripts. A yearly increase in c‐POCUS publications was observed. Nearly half of publications were original research (48.8%) followed by case report or series (22.8%). Most publications had an emergency medicine senior author (38.5%), followed by cardiology (20.8%), anesthesiology (12.5%), and critical care (12.5%). The proportion authored by emergency medicine and cardiologists has decreased over time while those by anesthesiology and critical care has generally increased, particularly over the last decade. First authorship demonstrated a similar trend. Articles were published in emergency medicine (24.4%) and cardiology journals (20.5%) with comparable frequency. Conclusion The annual number of c‐POCUS publications has steadily increased over time, reflecting the increased recognition and utilization of c‐POCUS. This study can help inform clinicians of the current state of c‐POCUS and augment the discussion surrounding barriers to continued adoption across all specialties.

Background Clinically evident cardiac involvement has been documented in 5% of sarcoidosis patients, primarily manifesting as heart block, ventricular arrhythmias, and heart failure. Heart Rhythm Society consensus guidelines recommend advanced cardiac imaging with fluorodeoxyglucose–positron emission tomography (FDG-PET) scan for diagnosis of cardiac sarcoidosis, given endomyocardial biopsy’s low sensitivity. Case summary  We describe four patients with cardiac sarcoidosis diagnosed with FDG-PET scan performed using a standardized imaging protocol for cardiac sarcoidosis. Serial FDG-PET scans were performed to monitor disease progression and response to therapy. Patients 1 and 2 presented with heart block, Patient 3 with heart failure and ventricular tachycardia (VT), and Patient 4 with VT. Patient 1 showed an initial decrease in standard uptake value (SUV) on immunosuppression, followed by an increase in SUV, necessitating steroid therapy. Patient 2’s SUV decreased on immunosuppression. Patient 3 required 3.5 years of immunosuppression for the SUV to decrease to inactive disease levels, with SUV increasing and decreasing at different times during treatment, and subsequently developed VT. For Patient 4, areas of inflammation on the initial scan matched low voltage areas on the patient’s EP study, confirming the arrhythmia’s pathophysiological basis. Discussion  Cardiac sarcoidosis progression and response to therapy are heterogeneous. Serial FDG-PET scans are useful to diagnose disease, tailor therapy, and monitor the clinical course of disease, allowing treatment decisions to be based on the quantitative level of inflammation seen on FDG-PET.

Background: Sedation is an essential component of the transesophageal echocardiography (TEE) procedure for patient comfort. Utilization and the clinical implications of cardiologist-supervised (CARD-Sed) versus anesthesiologist-supervised sedation (ANES-Sed) are unknown. Methods: We reviewed non-operative TEE records from a single academic center over a five-year time period and identified CARD-Sed and ANES-Sed cases. We evaluated the impact of patient comorbidities, cardiac abnormalities on transthoracic echocardiogram (TTE), and the indication for TEE on sedation practice. We analyzed the use of CARD-Sed versus ANES-Sed in light of institutional guidelines, the consistency in the documentation of pre-procedural risk stratification, and the incidence of cardiopulmonary events including hypotension, hypoxia and hypercarbia. Results: A total of 914 patients underwent TEE, with 475 (52%) receiving CARD-Sed and 439 (48%) ANES-Sed. The presence of obstructive sleep apnea (p=0.008), a BMI greater than 45kg/m (p<0.001), an EF of less than 30% (p<0.001) and pulmonary artery systolic pressure of more than 40 mm Hg (p=0.015) were all associated with the use of ANES-Sed. Of the 178 (19.5%) patients with at least one caution to non-anesthesiologist-supervised sedation by the institutional screening guideline, 65 (36.5%) underwent CARD-Sed. In the ANES-Sed group, where intraprocedural vital signs and medications were documented in all cases, hypotension (n = 91, 20.7%), vasoactive medication use (n=121, 27.6%), hypoxia (n= 35, 8.0%), and hypercarbia (n= 50, 11.4%) were noted. Conclusions: This single-center study revealed that 56% of the non-operative TEE utilized ANES-Sed over five years. Sedation-related hemodynamic changes and respiratory events were not infrequently encountered during ANES-Sed.