Otago graduate, PGY2 House Officer at Christchurch Public Hospital. Worked alongside Assoc. Prof Jardine and Dr Adam Ng who helped create this abstract from a routine HO audit. Keen to involve more practical procedural skills for House Officer learning, including echocardiogram, especially in larger hospital centres where practical experience can be hard to gain. Mid term goals include experiencing a broad range of medical topics before getting some overseas work experience.
How Early Bedside Echocardiogram Changes Management of Acute Medical Patients
General Medicine (GM) patients are often elderly with multiple pathologies and difficult to
diagnose during a brief admission. Expensive monitoring tests are often initiated prior to knowing basic
heart function. We planned a prospective study to echocardiogram (echo) acute medical patients
admitted to hospital. We recorded the working diagnosis, physical findings, echo results and how this
Patients admitted acutely with cardiac symptoms were categorised into four
main groups: [dyspnoea, chest pain, murmur of uncertain aetiology and syncope]. Initially
their physical findings [particularly JVP, murmurs] were reviewed at bedside. Echo was
undertaken by team members and overseen by DJ. Results were recorded in dedicated
notes and echo machine. Echo results were correlated with working diagnosis, history and physical
findings. The authors then considered how this changed management.
One hundred patients were echoed consecutively over a six-month period between March and
Sept 2019 on our acute medical wards. Mean age 76.4, range 39 – 94; males: 47, females: 53.
Presentations were categorised as planned – dyspnea 50/100; chest pain 14/100; syncope 15/100,
murmur 5/100; others 16/100. Common abnormal features found on bedside echo were; Valvular
dysfunction (59/100), Decreased systolic function (28/100), Dilated cardiomyopathy (27/100),
Hypertrophic ventricle – (28/100) and pericardial effusion (7/100). Number of cases in which the echo
result changed management was 73/100. Management changes included; medication changes 29%
(21/73), early discharge/referral to other service 12% (9/73), helping guide diagnosis 49% (36/73) and
further tests required 9.5% (7/73).
Cardiac bedside echo is an early initiative in GM. Although guidelines do not mandate
echo on admission, we believe it is important to clarify as much detail as possible prior to starting
treatment. Our results support the concept that echocardiograms can provide concise, important
information about cardiac function efficiently on admission to guide management and
improve patient care.