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Emergency Medicine > CARDIOVASCULAR
Ultrasonography, Cardiac
Article Last Updated: Jan 8, 2007
AUTHOR AND EDITOR INFORMATION
Section 1 of 7  
Author: Verena T Valley, MD, Associate Professor, Director of Ultrasound, Department of Emergency Medicine, University of Mississippi School of Medicine
Verena T Valley is a member of the following medical societies: American College of Emergency Physicians
Coauthor(s):
Christopher A Fly, MD, Assistant Professor, Department of Emergency Medicine, Medical College of Georgia
Editors: Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Gary Setnik, MD, Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School; John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center; Pamela L Dyne, MD, Associate Professor, Program Director, Department of Medicine, Division of Emergency Medicine, University of California at Los Angeles School of Medicine
Author and Editor Disclosure
Synonyms and related keywords:
echocardiography, transthoracic echocardiography, echo, transesophageal echocardiography, cardiac ultrasonography, cardiac sonogram
Background
Echocardiography is particularly useful in emergency medicine for a variety of cardiac disorders. It affords a rapid, noninvasive, and dynamic profile of the heart for many conditions in patients presenting to the ED.
Mortality/Morbidity
Early diagnosis of cardiac dysfunction or significant injuries can prevent morbidity and mortality and have a positive effect on patient outcome.
- Penetrating cardiac injury: Immediate identification of penetrating cardiac injuries with ED echocardiography can improve survival rates and neurologic outcomes.
- Nontraumatic cardiac rupture: Patients with cardiac rupture as a complication of acute myocardial infarction usually have a poor outcome. Early identification with echocardiography can enhance survival and prevent administration of thrombolytic therapy, which would have catastrophic results.
- Nontraumatic pericardial effusion: Prompt identification may guide therapy in view of this potentially difficult diagnosis.
- Pulmonary embolus: Patients in whom pulmonary embolus with right ventricular hypokinesis is demonstrated with echocardiography may benefit from thrombolytic therapy.
- Pulseless electrical activity: Echocardiograph may reveal potentially treatable causes of this condition.
Physical
Findings at physical examination are nonspecific and nonsensitive in determining a patient's hemodynamic status.
Causes
Clinical indications for emergency echocardiography include the following:
- Penetrating trauma
- Blunt trauma
- Hypotension
- Pulseless electrical activity
- Performance of cardiopulmonary resuscitation
- Acute myocardial infarction
- Mechanical complications of acute myocardial infarction
- Nontraumatic cardiac rupture
- Atypical chest pain
- Syncope in young adults
- Great-vessel disease
- Iatrogenic complications due to invasive procedures
- Evaluation of the unstable patient
Imaging Studies
- Echocardiographic windows useful in emergency medicine include the following:
- The subcostal view is preferred at initial screening for mechanical activity and pericardial fluid and for gross assessment of global and regional abnormalities.
- The parasternal view allows visualization of the aortic valve, proximal ascending aorta, and posterior pericardium and allows determination of left ventricular size. It is particularly helpful when the subcostal view is difficult to obtain.
- To obtain a subcostal view, place the transducer the left subcostal margin with the beam aimed at the left shoulder.
- To obtain a parasternal view, place the transducer in the left parasternal area between the second and fourth intercostal spaces. The plane of the beam is parallel to a line drawn from the right shoulder to the left hip.
Other Tests
- Transesophageal echocardiography has been used in blunt and penetrating trauma to identify aortic and ventricular injuries. It is particularly useful in the early identification of traumatic rupture of the aorta.
Emergency Department Care
ED care can be guided and enhanced with limited echocardiography.
Consultations
When a pericardial effusion or cardiac rupture is found on ED evaluation, a cardiologist and/or cardiothoracic surgeon should be consulted.
| Media file 1:
Ultrasonography, cardiac. This image depicts a normal subcostal view of the heart. The pericardium is a bright reflector surrounding the heart. All 4 chambers of the heart can be seen. |
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| Media file 2:
Ultrasonography, cardiac. This subcostal image of the heart depicts clotted blood (Hem) in the pericardium after a stab wound to the chest. |
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| Media file 3:
Ultrasonography, Cardiac. This subcostal image demonstrates a dark layer in the pericardium representing a pericardial effusion. |
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| Media file 4:
This thick, dark (anechoic) stripe represents pericardial fluid. A pleural effusion can mimic a pericardial effusion on some echocardiographic views. |
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Media type: Ultrasound
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Ultrasonography, Cardiac excerpt Article Last Updated: Jan 8, 2007
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