Acute heart failure is defined as hemodynamic instability of cardiac causes. It is a class I indication for the performance of echocardiography. The first line technical modality is transthoracic echocardiography (TTE). Echocardiography can be effectively utilized to differentiate cardiac from noncardiac causes. In cardiac emergencies urgent echocardiography has a high diagnostic yield. The following emergency interventions can be based on echocardiography findings: thrombolysis in acute myocardial infarction with nondiagnostic ECG, or in massive pulmonary embolism, or in prosthetic valve thrombosis; surgery for postinfarction freewall rupture, septal rupture or papillary muscle rupture, for acute aortic dissection, for acute native or prosthetic valve regurgitation and pericardiocentesis or fenestration for cardiac tamponade. The standard method for hemodynamic assessment of patients in acute heart failure has been Swan Ganz catherization. Doppler echocardiography, however, became a realistic alternative to this invasive technique. Doppler echocardiography is successfully utilized to measure right ventricular (pulmonary artery) systolic pressure, often pulmonary artery diastolic pressure, to assess left ventricular filling pressure, particularly in patients with left ventricular systolic dysfunction; to accurately measure cardiac output and even to measure pulmonary vascular resistance in transplant candidates. Transesophageal echocardiography should be chosen if transthoracic echocardiography is inadequate and in special indications. Acute heart failure presents 25% of emergency transesophageal examinations. Transesophageal can be safely used in these critically ill patients with high diagnostic accuracy. Echocardiography should be performed immediately, or urgently in patients with hemodynamic instability or acute heart for diagnostic and hemodynamic evaluation, to initiate prompt therapeutic interventions.
|Translated title of the contribution||The role of echocardiography in acute heart failure|
|Number of pages||6|
|Journal||Lege Artis Medicinae|
|Publication status||Published - May 3 1999|
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