SDMS CME Credit – The Diagnostic Value of Echocardiography Performed By EM Physician in Diagnosis of Acute Coronary Syndrome: A Comparative Study with a Cardiologist

Article: The Diagnostic Value of Echocardiography Performed By EM Physician in Diagnosis of Acute Coronary Syndrome: A Comparative Study with a Cardiologist

Authors: Özgür Çevrim, MD, Bahar Boydak, MD, Aslıhan Yürüktümen, MD, G.Selahattin Kiyan, MD, Murat Ersel, MD, İlhan Uz, MD, Enver Özçete, MD, and Güneş Başol, MD

Category: Cardiac (Adult) [AE]

Credit: 1.0 SDMS CME Credit

Objectives: After studying the article you will be able to:

• Recognize the context of this study in comparing the diagnostic accuracy of an emergency-department physician conducting echocardiography with the diagnostic cardiologist’s interpretation of the echocardiogram.

• Identify the Segmental Wall Movement Abnormality (SWMA) Score for calculation and Results to Diagnose Acute Coronary Syndrome.

• Discuss the importance of bedside-focused echocardiography in patients with an undocumented Segmental Wall Abnormality (SWMA) presenting with Acute Coronary Syndrome (ACS) in regard to treatment timing for possible recanalization and further morbidity and mortality reduction.

1. The clinical manifestations of Coronary Artery Disease include:

2. Dizziness and / or vertigo

3. Silent ischemia

4. Forgetfulness

Acute Coronary Syndrome must meet at least the following two conditions for diagnosis:

Serial ECG changes and Shortness of Breath

Elevation in serum cardiac markers and Upper Extremity pain

Ischemic type of chest pain and/or chest discomfort and elevation in serum cardiac markers

Ischemic type of chest pain and/or chest discomfort and Unilateral Mandibular pain.

Wall measurements and Echocardiography views used in this study include:

Suprasternal Notch, Parasternal Long-Axis, Apical Four-Chamber, Apical Five Chamber

Apical Two-Chamber, Parasternal Short-Axis, Apical Four-Chamber, Parasternal Long-Axis

Apical Four-Chamber, Parasternal Long-Axis, Apical Four Chamber, Apical Five Chamber

Subcostal View, Parasternal Long-Axis, Parasternal Short-Axis, Parasternal Two - Chamber

In comparing the results scored by the Emergency Room Physician performing the Echocardiogram compared to the Cardiologist assessment, what areas of the heart were the weakest in correlation?

Parasternal Short-Axis basal inferoseptal, Parasternal Short-Axis basal anteroseptal

Parasternal Short-Axis basal anterior, Parasternal Short-Axis mid-anterior

Parasternal mid-anteroseptal, Parasternal Short-Axis basal inferolateral

Parasternal Short-Axis apex anterior, Parasternal Short-Axis mid-anterolateral

Echocardiography’s sensitivity in predicting cardiac events within 4 hours of presentation compared to Electrocardiograms (ECG) was found to be:

Echocardiography 78%, ECG 95%

ECG 49%, Echocardiography 98%

Echocardiography 76%, ECG 24%

ECG 40%, Echocardiography 91%

Segmental Wall Movement Abnormality (SWMA) scoring assists in the timing of treatment for which a delay in treatment for ACS can lead to increased morbidity. Based on SWMA scoring, what value amount of the SWMA score is used to initiate immediate treatment for Acute Coronary Syndrome?

3 out of 17 total SWMA scoring

1 out of 17 total SWMA scoring

12 out of 17 SWMA scoring

2 out of 17 SWMA Scoring

What can be implemented in order to overcome a weak correlation in comparing Segmental Wall Motion Abnormality (SWMA) within the sixth-hour troponin levels?

Repeat Electrocardiogram (ECG) at least 3 times in the initial sixth -hour troponin levels every two hours.

Repeat focused echocardiography within the first three hours of the initial sixth -hour troponin levels.

Repeat focused echocardiography at the fourth or sixth hour of the initial sixth -hour troponin levels.

Repeat both the ECG and focused echocardiography exam every hour up to six hours.