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Sinnvolle Diagnostik in der Notaufnahme

Echokardiographie

Appropriate diagnostics in emergency admission

Echocardiography

Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Die Echokardiographie ist das zentrale bildgebende Verfahren zur Diagnostik myokardialer, valvulärer und struktureller Herzerkrankungen. Die koronare Herzkrankheit ist über linksventrikuläre Funktionsstörungen erkennbar. In der Notaufnahme bietet die rasche bettseitige Einsatzmöglichkeit beim instabilen Patienten, der eine sofortige Diagnostik und Therapie erfordert, entscheidende Vorteile. Die sog. „Appropriateness Criteria“ sehen die Nutzung der Echokardiographie bei folgenden Notfallsituationen vor: 1) Beurteilung des Patienten mit Hypotension oder hämodynamischer Instabilität, 2) Beurteilung des Patienten mit myokardialer Ischämie oder Infarkt, 3) Beurteilung des Patienten mit respiratorischem Versagen bei Verdacht auf kardiale Genese und 4) Nutzung der Echokardiographie bei Verdacht oder gesicherter Lungenembolie zur Therapiesteuerung. Die Echokardiographie hilft weiter bei der differenzialdiagnostischen Klärung thorakaler Schmerzen. Der sinnvolle Einsatz kann gerade in der Notaufnahme eine entscheidende, weichenstellende Funktion haben. Jedoch ist die Nutzung der Echokardiographie aufgrund der starken Untersucherabhängigkeit der Methode auch in der Notaufnahme von einem adäquat ausgebildeten Untersucher durchzuführen.

Abstract

Echocardiography is the central imaging modality for the diagnosis of myocardial, valvular and structural heart disease. Coronary artery disease can be detected by impaired left ventricular function. The rapid bedside application in unstable patients requiring immediate diagnostics and treatment is a decisive advantage of echocardiography. The so-called appropriateness criteria propose the use of echocardiography in the following emergency situations: (1) assessment of patients with hypotension or hemodynamic instability, (2) assessment of patients with myocardial ischemia or infarction, (3) evaluation of patients with respiratory failure and suspected cardiac origin and (4) application of echocardiography in suspected or proven pulmonary embolism for treatment decisions. Echocardiography also has an important impact in the differential diagnosis of chest pain symptoms. The application of echocardiography in the emergency department may set the course for understanding of the underlying disease processes as well as the required treatment strategy. Due to the operator dependency of the technique, a meaningful application of echocardiography requires an experienced investigator even in the emergency department.

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Literatur

  1. AWMF Leitlinienregister VASA 2010 S/78 Interdisziplinäre S2 Leitlinie Diagnostik und Therapie der Venenthrombose und der Lungenembolie

  2. Breitkreutz R, Walcher F, Seeger FH (2007) Focused echocardiographic evaluation in resuscitation management: concept of an advanced life support-conformed algorithm. Crit Care Med 35(5 Suppl):150–161

    Article  Google Scholar 

  3. Douglas PS, Khandheria B, Stainback RF et al (2007) ACCF/ASF/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American Society of Echocardiography, American College of Emergency Physicians, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance endorsed by the American College of Chest Physicians and the Society of Critical Care Medicine. J Am Coll Cardiol 50:187–204

    Article  PubMed  Google Scholar 

  4. Evangelista A, Mukherjee D, Mehta RH et al (2005) Acute intramural hematoma of the aorta: a mystery in evolution. Circulation 111:1063–1070

    Article  PubMed  Google Scholar 

  5. Evangelista A, Avegliano G, Aguilar R et al (2010) Impact of contrast-enhanced echocardiography on the diagnostic algorithm of acute aortic dissection. Eur Heart J 31:472–479

    Article  PubMed  Google Scholar 

  6. Gaibazzi N, Reverberi C, Badano L (2011) Usefulness of contrast stress-echocardiography or exercise-electrocardiography to predict long-term acute coronary syndromes in patients presenting with chest pain without electrocardiographic abnormalities or 12-h troponin elevation. Am J Cardiol 107:161–167

    Article  PubMed  Google Scholar 

  7. Hoffmann R, Bardeleben S von, Kasprzak JD et al (2006) Analysis of regional left ventricular function by cineventriculography, cardiac magnetic resonance imaging, and unenhanced and contrast-enhanced echocardiography: a multicenter comparison of methods. J Am Coll Cardiol 47:121–128

    Article  PubMed  Google Scholar 

  8. Labovitz AJ, Noble VE, Bierig M et al (2010) Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr 23:1225–1230

    Article  PubMed  Google Scholar 

  9. Mandavia DP, Hoffner RJ, Mahaney K, Henderson SO (2001) Bedside echocardiography by emergency physicians. Ann Emerg Med 38:377–382

    Article  PubMed  CAS  Google Scholar 

  10. Mulvagh SI, Rakowski H, Vannan MA et al (2008) American Society of Echocardiography consensus statement on the clinical applications of ultrasonic contrast agents in echocardiography. J Am Soc Echocardiogr 21:1179–1201

    Article  PubMed  Google Scholar 

  11. Nienaber CA, Kische S, Skriabina V, Ince H (2009) Noninvasive imaging approaches to evaluate the patient with known or suspected aortic disease. Circ Cardiovasc Imaging 2(6):499–506

    Article  PubMed  Google Scholar 

  12. Sabia P, Abbott RD, Afrookteh A et al (1991) Importance of two-dimensional echocardiographic assessment of left ventricular systolic function in patients presenting to the emergency room with cardiac-related symptoms. Circulation 84:1615–1624

    Article  PubMed  CAS  Google Scholar 

  13. Salem P, Melniker L, Chooljian C et al (2005) Does the presence or absence of sonographically identified cardiac acitivity predict resuscitation outcomes of cardiac arrest patients? Am J Emerg Med 23:459–462

    Article  Google Scholar 

  14. Seward JB, Douglas PS, Erbel R et al (2002) Hand-carried cardiac ultrasound (HCU) device: recommendations regarding new technology. A report from the Echocardiography Task Force on new technology of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 15:369–373

    Article  PubMed  Google Scholar 

  15. Toosi MS, Merlino JD, Leeper KV (2008) Prognostic value of the shock index along with transthoracic echocardiography in risk stratification of patients with acute pulmonary embolism. Am J Cardiol 101:700–705

    Article  PubMed  Google Scholar 

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Hoffmann, R. Sinnvolle Diagnostik in der Notaufnahme. Med Klin Intensivmed Notfmed 108, 209–213 (2013). https://doi.org/10.1007/s00063-012-0136-8

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  • DOI: https://doi.org/10.1007/s00063-012-0136-8

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