Acute Heart Failure: The Role of Focused Emergency Cardiopulmonary Ultrasound in Identification and Early Management

Patients presenting to the Emergency Department (ED) with acute heart failure (AHF) represent a heterogeneous group in terms of clinical presentation, pathophysiology, and prognosis, with symptoms ranging from a mild increase in their baseline exertional dyspnoea to severe cardiogenic shock. Rapidly distinguishing AHF from other common causes of dyspnoea is the cornerstone to appropriate management and risk stratification. When ED physicians base their diagnosis of AHF on history and physical exam only, misdiagnosis rates may be as high as 33%.1 Ancillary testing helps, but, even after chest radiography and natriuretic peptide testing, the diagnosis may still be unclear in 15–20% of patients.2-4 Little has changed, in terms of ancillary testing, in the past two decades to help physicians rapidly diagnose and then appropriately treat AHF in the ED. Current ED management paradigms do not consider urgent assessment of myocardial structure, function, or haemodynamics to be of much value for many patients. However, we believe that assumption to be misguided, especially now that point-of-care ultrasound has become a core component of training for ED physicians. We believe using focused bedside ultrasound assessment of the cardiopulmonary system during an AHF episode at the time of ED presentation would improve ED diagnostic accuracy, assist with acute management, and direct initial therapeutic decisions in these complex patients who often present with undifferentiated symptoms.