Role of two-dimensional echocardiography in the emergency room

To assess the role of two-dimensional echocardiography in the emergency room, 2DE was performed with a portable unit in 70 patients with a wide spectrum of cardiovascular problems. The indications were acute chest pain syndromes in 28 patients and assessment of various other cardiovascular problems in 42 patients, including: ventricular function, 9; pericardial effusion or tamponade, 5; cardiac contusion, 8; cardiac source of embolus, 6; unexplained syncope, 4; aortic aneurysm, 5; and abnormal auscultation or electrocardiogram, 5. The 2DE studies were technically satisfactory in 68 patients (97%); they were not adequate in 2 patients with acute chest pain syndromes. Five of 26 patients with acute chest pain syndromes had left ventricular regional wall motion abnormalities, and each had a subsequent diagnosis of myocardial infarction. Two patients with non-Q-wave myocardial infarction did not show regional wall motion abnormalities. In the patients with various other cardiovascular problems, 2DE was useful in assessing: degree of pericardial effusion in 3 patients, which led to 2DE-guided pericardiocentesis in 2; cause of 'electromechanical dissociation' during cardiac resuscitation in 1; severity of ventricular dysfunction in 7; presence of cardiac thrombus in 2; and presence and size of aortic aneurysm in 3. Thus, in the emergency room, 2DE appears to be a valuable adjunctive technique for noninvasive cardiovascular diagnosis and may be particularly useful in the triage of patients with acute chest pain syndromes.