Cardiovascular examination is traditionally performed exclusively with the use of a stethoscope since its invention nearly 200 years ago. Such a clinical examination is notoriously unreliable and doesn't always convey sufficient information regarding the structural and physiological integrity of the heart.
The mechanical complications of acute myocardial infarction include four types of pathological conditions: free wall rupture, papillary muscle rupture, ventricular septal rupture, and double structural rupture [VSR?+?FWR]. If untreated, 80% mortality rate in the first week been reported.
Myocarditis is the inflammation of the heart muscle and typically attacks otherwise healthy people, including children and young adults. Patients with severe acute myocarditis have a better prognosis, while patients with moderate chronic myocarditis are more prone to develop heart failure. It is difficult to diagnose, tough to treat, and if left undetected, it can kill.
Acute aortic dissection in the emergency department (ED) remains one of the riskiest clinical and medicolegal challenges facing ED physicians. The variability in clinical presentations and mimics, the unreliability of clinical assessments and initial screening tools, and the need for advanced imaging all present obstacles in making an accurate and timely diagnosis for this entity.
In everyday practice, clinicians use knowledge, clinical acumen and problem-solving skills to arrive at a diagnosis. In order to aid the clinician to reach the correct aetiologies, they must be presented with the maximum relevant information. Inadequate information and flawed processing of available information form crucial factors in diagnostic error.
Trans-thoracic echocardiogram [TTE] is the most powerful tool available to the emergency physician, helping to improve diagnostic accuracy and revealing the aetiology of unexplained hypotension. An optimal TTE study in such an acute care setting may not be achievable, and echocardiography in this setting frequently requires non-standardized echocardiographic views.
I present a few cases in emergency medicine where bedside echocardiogram was pivotal in the management. If emergency physicians were to incorporate basic TTE in their skillset, such high mortality cases of undifferentiated shock can be diagnosed promptly in the emergency department and appropriate therapy and referral will result in improved survival.