CHEST Guidelines-Point-of-Care-Ultrasonography-for-Acute-Coronary-S

Point-of-Care-Ultrasonography-for-Acute-Coronary-S

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The provided document discusses the use of point-of-care ultrasonography (PoCUS) in emergency settings, specifically for evaluating acute dyspnea and diagnosing conditions like acute coronary syndrome (ACS). The correspondence, authored by Li-Ta Keng, MD, highlights a study by Zanobetti et al., demonstrating that PoCUS can significantly shorten diagnostic time compared to traditional emergency department (ED) diagnostics. The study cited by Keng reveals a high specificity of PoCUS for ACS diagnosis, though Keng notes that it lacks detailed criteria for diagnosing ACS solely based on PoCUS findings.<br /><br />The study involved the qualitative evaluation of left ventricular systolic function and detection of right ventricular dilation and pericardial effusion. However, it did not routinely assess left ventricular wall motion asymmetry, which is crucial for ACS diagnosis. Keng emphasizes that the findings likely reflect exclusion of other PoCUS patterns combined with electrocardiographic assessments rather than specific PoCUS indicators for ACS.<br /><br />Further, Keng points out that the detailed analysis of left ventricular segmental wall motion is beyond the scope of focused cardiac ultrasonography in emergency settings. This complexity might limit the generalizability of using PoCUS for ACS within the ED, as detailed in a consensus statement by the American Society of Echocardiography and the American College of Emergency Physicians.<br /><br />The document also includes correspondence on financial disclosures, contact information for the authors involved, and references to several studies related to sepsis, thiamine supplementation, and PoCUS applications. The response section acknowledges Dr. Keng's contributions and provides additional discussions on the study results. Overall, the document highlights the potential and limitations of PoCUS in rapidly diagnosing acute medical conditions in emergency settings.

Keywords

PoCUS

acute dyspnea

acute coronary syndrome

emergency settings

diagnostic time

left ventricular function

right ventricular dilation

pericardial effusion

electrocardiographic assessments

cardiac ultrasonography