Bedside echocardiography by emergency physicians in acute myocardial infarction

Purpose: Echocardiography is a non invasive diagnostic technique that uses ultrasound waves to create images of the heart. It is comprised in training programs in ultrasound medical emergency of prestigious international scientific societies, such as WINFOCUS (World_Interactive_Network Focused_on_Critical_Ultrasound), and the American College of Emergency Physicians (ACEP). The current scientific evidence supports the use of echocardiography by emergency physicians for its speed, agility and safety for the patient.

Material and method: Case study of the diagnosis of an interventricular communication as mechanical complication of anterior septal myocardial infarction, using echocardiography performed by Emergency Physician. We used a Sonosite M-Turbo, P21 probe of between 1 and 5 MHz, and echocardiography software.

Results: 85 year old female, obese, hypertense and diabetic, with poor quality of life, attended at emergency room for oppressive chest pain with several days of evolution, presenting sickness, sweating, tachycardia and severe hypotension (70/30). Showing an ECG with ST segment elevation with Q wave formation in the precordial leads (V1-V6). The EP performed a bedside echocardiography, observing a discontinuity at the level of apical interventricular septum with left-right shunt and dyskinesia at medium-apical septum and anterior akinesia, fully compatible with the anterior myocardial evolved, with break septal... a postinfarct interventricular communication. Given this findings and her quality of life, the patient was sent to have an urgent catheterization, starting with sedation and analgesia. she finally died after 24 hours of arrival at the hospital.

Conclusions: Incorporating emergency echocardiography lowers the overall service time, since the emergency physician can be more effective, efficient and dynamic when handling “time-dependent” emergencies, providing greater clinical patient safety. Unfortunately, in this case the patient could not benefit from curative treatment, but avoided echocardiography to undergo unnecessary interventionism, which would not have prevented the fatal outcome.