echocardiography

Point-of-Care Screening Echocardiograms and their Potential Utility in the Acute Inpatient Medical Setting

Original Articles, Volume 19, Issue 4, Pages 173 – 252 (2020)

Demands on echocardiography services are increasing annually. This Quality Improvement Project aimed to see whether a point of care screening echocardiography (SE) service in the acute inpatient medical setting might help reduce demand on full trans-thoracic echocardiography services (FE). The indication and results of all FE requests on the admission ward were analysed over a three-month period. Following this, it was considered whether a theoretical SE occurring prior, would have changed the on-going utilisation of FE resources. Of the 67 requests analysed, 57 underwent FE. 25% revealed no abnormality. In 47%, a SE prior may have changed the future use of FE resources. This small retrospective review highlights the potential benefits of a SE service and further work is required.

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Dissecting the Diagnosis – An Unusual Case of Pericarditis

Case Reports, Volume 16, Issue 4, Pages 153 – 212 (2017)

Abstract

Chest pain is an extremely common presenting complaint on the acute medical unit. It is important to distinguish between patients who have serious pathology and those without. Often, the focus is on ruling out an acute coronary syndrome and inadequate consideration is given to other possible causes.

This case highlights the importance of performing relevant investigations in a timely manner, in order to ensure that a correct diagnosis is made.

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A UK wide survey on attitudes to point of care ultrasound training amongst clinicians working on the Acute Medical Unit

Research Audit and Clinical Practice, Volume 14, Issue 4, Pages 145 - 196 (2015)

Abstract

The use of point of care ultrasound (POCU) is increasing across a number of specialties, becoming mandatory within some specialist training programmes (for example respiratory and emergency medicine). Despite this, there are few data looking at the prevalence of use or the training clinicians have undertaken; this survey sought to address this. It shows that the majority of POCU undertaken on the Acute Medical Unit (AMU) is without formal accreditation, with significant barriers to training highlighted including a lack of supervision, time and equipment. For those who undertook POCU, it was shown to regularly speed up clinical decision making, while 76.3% respondents believed a lack of access to POCU out of hours may affect patient safety. The data provide support to the concept of developing AMU specific POCU accreditation, to ensure robust and safe use of this modality on the AMU.

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Pulmonary embolism in a patient with “isolated syncope”, a diagnostic challenge

Case Reports, Volume 14, Issue 1, Pages 1 - 40 (2015)

Abstract

Syncope is a recognized presenting symptom in patients with pulmonary embolism (PE), and is more common in older patients and following a large embolus. Isolated syncope, in the absence of dyspnea or tachycardia, is uncommon in this setting, and may be misdiagnosed as cardiac in origin, leading to a delay in appropriate treatment. We present a case which illustrates the importance of consideration of pulmonary embolism in the differential diagnosis of patients presenting with syncope, and the value of echocardiography in its diagnosis.

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24 hour availability of echocardiography in Acute Medicine: time to get out of our ‘silos’!

Correspondence, Volume 11, Issue 3, Pages 129 - 185 (2012)

Dear Sir,

I read with interest the article by Ravikirti et al in the recent edition of Acute Medicine. The authors rightly highlight the potential for atypical presentations of tamponade following cardiac surgery, which has been reported previously. The investigation of any acutely unwell patient presenting after cardiac surgery should include some form of cardiac imaging. In the cases described the diagnosis was delayed, in part, due to the lack of an echocardiography service out-of-hours.

24 hour availability of echocardiography in Acute Medicine: time to get out of our ‘silos’! Read More

Cardiac Tamponade: atypical presentations after cardiac surgery Ravikirti & R Karadi

Case Reports, Volume 11, Issue 2, Pages 57 - 124 (2012)

Abstract

We present two cases of cardiac tamponade presenting in the aftermath of cardiac surgery. We have briefly discussed the aetiology, presentation, diagnosis and management of the condition with emphasis on its atypical presentation in postoperative patients. A high index of suspicion and early access to echocardiography is necessary for prompt recognition and treatment of this life threatening emergency.

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The management of acute pericarditis

Original Articles, Volume 4, Issue 2, Pages 45 - 80 (2005)

Abstract

Acute pericarditis is usually a benign self-limiting condition, often of unexplained or viral aetiology, involving inflammation of the pericardial layers. It is often part of the differential diagnosis in patients admitted with acute chest pain and can be confused with acute myocardial infarction, acute pulmonary embolism and pleurisy. Occasionally it can result in cardiac tamponade and, if associated with myocarditis, in heart failure. This article sets out how to diagnose acute pericarditis, the common underlying causes, the possible treatment options and outcomes.

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