Moving the needle towards the democratization of echocardiography: a case report

Abstract

Background Echocardiography has been traditionally performed in echo labs and the potential benefits of its use by primary care physicians (PCPs) are still unexplored. We present a case where POCUS (point-of-care ultrasound) was used as a complement of physical examination by a family doctor, allowing a prompt clinical decision in a heart failure (HF) patient. Case summary An 85-year-old woman, living independently, asks her family doctor for a home consultation due to increasing dyspnoea. On examination, severe dyspnoea and bilateral ankle oedema was noted and a point-of-care echocardiogram was performed by the primary care physician, who observed: severely compromised left ventricular systolic function, moderate mitral and tricuspid regurgitation, and severe dilation of the inferior vena cava. As a result, the diagnosis of HF with decreased ejection fraction was formed supporting the therapeutic decision. Discussion This case represents an elderly patient with dyspnoea, without previous HF diagnosis. The primary care physician, used portable ultrasound as a complement of physical examination, which confirmed a HF diagnosis, allowing a prompt decision-making on therapy. POCUS, can be a powerful tool to expedite treatment in different settings, including the home consultations by PCPs.

POCUS - Point-of-Care Ultrasound: Advanced Physical Examination

“…Due to its portability, it can be used in different circumstances such as the emergency department, inpatient setting, medical office, transport of the patient or even at home visits. 1 In these scenarios, when facing a patient with abdominal pain, following clinical history and physical examination, the ability to perform differential diagnosis is significantly improved, for example in clinical scenarios such as renal colic, cholelithiasis, abdominal aortic aneurysm dissection, acute appendicitis or even an ectopic pregnancy. This is possible by having an ultrasound probe in the pocket, connecting it to the smartphone or tablet and proceed with the test.…”