Emergency department diagnosis of critical aortic stenosis using bedside ultrasonography
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CASE REPORT
Emergency department diagnosis of critical aortic stenosis using bedside ultrasonography David C. Riley • Grace Glassman • Kimberlee Hodges
Received: 26 August 2010 / Accepted: 26 October 2010 / Published online: 10 November 2010 Ó Springer-Verlag 2010
Abstract Introduction An 88-year-old woman with a history of coronary artery disease, hypertension, and a history of a large left upper lobe lung mass presented to the Emergency Department (ED) from a nursing home with rapidly progressive shortness of breath and chest pain over 1 day with a rapid decline in mental status. Bedside color Doppler ultrasound para-sternal long-axis examination of the heart revealed severe aortic stenosis. Bedside pulsed-wave and continuous-wave Doppler ultrasound in the apical 5-chamber view revealed critical aortic stenosis using the simplified continuity equation. Conclusion Bedside ED cardiac color Doppler, pulsed Doppler evaluation of the left ventricular outflow tract, and continuous-wave Doppler of the aortic valve were used to assist in the diagnosis of critical aortic stenosis. Keywords Ultrasound Critical aortic stenosis Pulsed-wave Doppler Continuous-wave Doppler Simplified continuity equation Aortic valve area
Case report An 88-year-old woman with a history of coronary artery disease, hypertension, and a history of a large left upper lobe
Electronic supplementary material The online version of this article (doi:10.1007/s13089-010-0047-y) contains supplementary material, which is available to authorized users. D. C. Riley (&) G. Glassman K. Hodges Emergency Medicine Department, Columbia University Medical Center, 622 West 168th Street, PH 1-137, New York, NY 10032, USA e-mail: [email protected]
lung mass presented to the Emergency Department (ED) from the nursing home with rapidly progressive and worsening shortness of breath and stuttering chest pain over 1 day with a rapid decline in mental status. Her ED vital signs were temperature 94°F, blood pressure 110/43 mmHg, respiratory rate 38 bpm, and room air oxygen saturation 81% which increased to 99% on 100% oxygen by non-rebreather. Electrocardiogram revealed normal sinus rhythm with a heart rate of 89 bpm and no ischemic changes. On physical examination, she was noted to be a very thin woman in moderate respiratory distress with a right sternal border systolic crescendo-decrescendo murmur and bilateral rhonchi breath sounds. She had no leg edema or tenderness to palpation. Portable chest X-ray showed bilateral pleural effusions and an unchanged left upper lobe lung mass. Initial laboratory studies revealed a BNP of 2,511 pg/mL. An initial ED bedside ultrasound was performed of the heart (see Video Clips S1, S2, and S3 available as supporting information in the online version of this paper). Examination of the heart with a low-frequency array cardiac probe in the para-sternal long-axis view revealed aortic stenosis, and the left ventricular outflow tract (LVOT) diameter was measured at 1.43 cm (Figs. 1, 2). A color Doppler zoomed-in parasternal lo
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