期刊
ANAESTHESIA CRITICAL CARE & PAIN MEDICINE
卷 40, 期 2, 页码 -出版社
ELSEVIER FRANCE-EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER
DOI: 10.1016/j.accpm.2021.100852
关键词
Point-of-care ultrasound; POCUS; Echocardiography; Pulmonary embolism; Right ventricular strain; Right ventricle; McConnell's sign; Tricuspid regurgitation; Pulmonary artery systolic pressure; Tricuspid annular plane systolic excursion; TAPSE; S'; Pulmonary artery mid-systolic notching; 60/60 sign; Pulmonary artery acceleration time; Speckle tracking
This manuscript reviews ten echocardiographic findings of right ventricular strain that may suggest a diagnosis of PE. Physicians must recognize and understand these findings and associated pathophysiology in order to expedite the diagnosis and treatment of PE.
Introduction: Pulmonary embolism (PE) is a potentially fatal disease encountered in the hospital setting. Prompt diagnosis and management can improve outcomes and survival. Unfortunately, a PE may be difficult to diagnose in a timely manner. Point-of-care ultrasound (POCUS) can assist in the evaluation for suspected PE by assessing for acute right ventricular strain. Physicians should thus be aware of these echocardiographic findings. Objective: This manuscript will review ten echocardiographic findings of right ventricular strain that may suggest a diagnosis of PE. It will provide a description of each finding along with the associated pathophysiology. It will also summarize the literature for the diagnostic utility of echocardiography for this indication, while providing reference parameters where applicable. Along with labeled images and video clips, the review will then illustrate how to evaluate for each of the ten findings, while offering pearls and pitfalls in this bedside evaluation. Discussion: The ten echocardiographic findings of right ventricular strain are: increased right ventricle: left ventricle size ratio, abnormal septal motion, McConnell's sign, tricuspid regurgitation, elevated pulmonary artery systolic pressure, decreased tricuspid annular plane systolic excursion, decreased S', pulmonary artery mid-systolic notching, 60/60 sign, and speckle tracking demonstrating decreased right ventricular free wall strain. Conclusions: Physicians must recognize and understand the echocardiographic findings and associated pathophysiology of right ventricular strain. In the proper clinical context, these findings can point toward a diagnosis of PE and thereby lead to earlier initiation of directed management. (C) 2021 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.
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