Role of Echocardiography in the Emergency Department

Many patients visit the emergency department (ED) with a chief complaint of chest pain. These patients require rapid and efficient triage to decide whether they require hospitalization or can be discharged. It is important to allocate resources appropriately to the highest-risk patients who require timely life-saving therapy, and clinicians must be able to identify the cause of chest pain, especially in life-threatening conditions, such as acute ischemic heart disease, cardiac tamponade, acute aortic dissection and pulmonary embolism (PE). Time is essential for the patients with chest pain. Early diagnosis and treatment also reduce morbidity and mortality in the critically ill patients with chest pain. Generally, electrocardiography (ECG) and cardiac biomarkers (e.g. CK-MB, troponin) can be used for the differential diagnosis of chest pain. However, electrocardiographic changes are often nonspecific in more than 50% of patients with chest pain. Cardiac biomarkers take hours from symptoms onset to exceed the normal range and can be influenced by renal functions. Because of these limitations, echocardiography can be useful in assessing patients with chest pain. This modality is ideal in the ED because it is rapid, accurate, and noninvasive and allows repeated examinations. Echocardiography can identify structural and functional changes associated with chest pain. Therefore, echocardiography plays an important role in the evaluation of different causes of chest pain, including coronary artery disease (CAD), pericardial disease, acute aortic disease, cardiomyopathy, and even pulmonary embolic events (Table 1). Transthoracic echocardiography (TTE) provides additional imaging capabilities, including Doppler and contrast echocardiography. The ACC/AHA committee provided guidelines for the clinical application of echocardiography in 1997, including indications in patients with acute chest pain (Table 2).