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Vol. 67. Issue 4.
Pages 332 (April 2014)
Vol. 67. Issue 4.
Pages 332 (April 2014)
Letter to the Editor
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Emergency Physicians Also Knocking on the Door of Echocardiography
Los médicos de urgencias también llaman a la puerta de la ecocardiografía
Javier Jacob
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Corresponding author:
, Ferran Llopis, Xavier Palom, Ignasi Bardes
Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
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Rev Esp Cardiol. 2014;67:168-7010.1016/j.rec.2013.07.010
Miguel Angel Garcia Fernandez
Rev Esp Cardiol. 2014;67:332-310.1016/j.rec.2013.11.013
Miguel Angel Garcia Fernandez
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To the Editor,

We thank Garcia Fernandez for his excellent editorial on echocardiography performed by noncardiology specialists.1 We would like to add that emergency physicians are also a group of professionals with a strong interest in improving the quality of our care through the application of noninvasive techniques such as basic clinical echocardiography, particularly for assessing patients with acute heart failure. In 45% of admissions, no prior echocardiographic information is available. Although this lack of information is not associated with a worse prognosis in the emergency room, we believe that it may lead to underuse of basic treatments with a recognized prognostic benefit.2 It would therefore seem to be common sense to introduce basic bedside echocardiography in the assessment of acute heart failure for certain selected patients.3 Thus, in our tertiary university hospital, which serves 1.5 million inhabitants, we have set up a training program in basic echocardiography with the following aims: detection of pericardial fluid, subjective estimation of ventricular function, assessment of presence of segmentary wall movement disorders, and measurement of chamber size. The training comprised a part dedicated to theory (8hours covering the principles of ultrasound scans and basic echocardiography) and a part to practice (25 to 30 echocardiographic studies under the supervision of cardiologists who work in the emergency room). The degree of satisfaction and acceptance of the technique was excellent; the extent to which the technique was applied in clinical practice was high. The main objective of echocardiography was subjective estimation of left ventricular function in 49%, detection of pericardial fluid in 33%, and assessment of shock and intravascular volume in 18% of cases. We also found that the learning curve was very steep, with appropriate choice of axis and identification of pericardial fluid in the first 5 echocardiographic studies. In addition, even in this short training period, participants were able to make a subjective assessment of cardiac contractility, segmental contraction defects, and dilation and size of atria and ventricles. All this information may help decide whether a patient with acute heart failure and previously undetected impaired ventricular contraction may benefit from a full work-up in the cardiology department. We should, however, be aware that our basic echocardiographic studies are in no way a substitute for those performed by specialists. We cannot stem the tide.

M.A. Garcia Fernandez.
¿Es posible entrenar a no cardiólogos para realizar ecocardiografía?.
Rev Esp Cardiol., 67 (2014), pp. 168-170
J. Jacob, P. Herrero, F.J. Martín-Sanchez, P. Llorens, O. Miró, R. Perelló, et al.
Estudio ECO-EAHFE: análisis de los pacientes con ecocardiografía realizada previamente a una visita en urgencias por episodio de insuficiencia cardiaca aguda.
Rev Clin Esp., 211 (2011), pp. 329-337
P. Llorens, O. Miró, F.J. Martín Sánchez, P.O. Herrero Puente, J. Jacob Rodríguez, V. Gil, et al.
Guía para el manejo de la insuficiencia cardiaca aguda en los servicios de urgencias, emergencias y unidades adscritas.
Emergencias., 23 (2011), pp. 119-139
Copyright © 2013. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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