Advances in Bedside Echocardiography

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Echocardiography img 1705Echocardiography is one of the most important, convenient, informative, and readily available cardiac imaging techniques. The cardiac imaging with ultrasound waves was introduced to the clinical practise in the early fifties of the last century. The first clinical application of the M-mode echocardiography was the assessment of the mitral valve from the shape of the waveforms. It first happened in Lund, and then the method became an established diagnostic tool that started to spread to China, Germany, U.S and finally worldwide.

In the late sixties, the contrast echocardiography was discovered, widely extending the range of applications of the technique. It was also in the late sixties when the transoesephageal echo was first applied allowing better visualisation of the left atrium and providing a lot of valuable information.
Advances in this cardiac imaging technique were followed by using the pulsed Doppler method, until the medical world knew the currently used colour Doppler echocardiography.

The early echocardiography machines were classically placed in the hospital's non-invasive cardiac lab. , and were double the size of home computers with a probe attached to it, a screen, and a keyboard with many buttons. They were used to assess the cardiac anatomy, and cardiac hemodynamics of the patients in an outpatient setting, or hospitalised patients who could be transferred to the cardiac lab. for running the tests.

Patients in the high dependency units like ICU & CCU form a patient population that would benefit greatly of the information supplied by the echocardiographic imaging which would help greatly in diagnosing a lot of conditions in this patient group, and guide the therapeutic efforts in the right direction, and that is the whole morale of the relatively recent bedside echo imaging with the new small sized portable echocardiography machines.

There are various indications for running a bedside echo study including patients with chest pain or dyspnea in an ER setting. Also patients with unexplained hypotension, suspected right or left-sided heart failure, as well as suspected pulmonary embolism in an ICU setting. Moreover, bedside echo is of extreme importance in diagnosing cardiac tamponade efficiently, which is a life threatening condition, and can guide an effective life saving pericardiocentesis.

The new portable echo devices provide the same image quality as the larger devices, and allow examination through the same conventional echo windows, like the parasternal long and short axis, the apical 4 and 5 chambers views, as well as the subxyphoid long axis view of the inferior vena cava. Moreover, it can be used for assessment of peripheral veins like the femoral and politeal veins which can be of importance in critically-ill patients in the ICU.

Though echocardiography is a great diagnostic tool, one of its major drawbacks is that it is operator dependent, and that is specifically true regarding bedside echo that is usually done to critically-ill patients and thus proper exposure and positioning won't always be easily obtained, as in running an echo for a patient with severe respiratory distress in an upright position, or running a test for patients with chronic obstructive pulmonary disease (COPD) with a poor parasternal view, and many other conditions that are frequently encountered in this patient subgroup, and that requires a very skilled echocardiographer to run the test rapidly and efficiently. It is still important to stress that in a context of critical illness, running a diagnostic bedside echo study should never delay emergent interventions as intubation, fluid resuscitation, pressor therapy, etc.

There are many commercially available portable echo devices that are the size of a laptop. Available models include, Siemens, Sonoscape, GE-Vivid portable, Philips, and many other models.

At last, we repeat that bedside echocardiography is a great diagnostic tool that could benefit the critically-ill patient population extremely, and guide the physicians' therapeutic efforts in the proper direction, it just needs to be in the right skilled hands to achieve its expected role.

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