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Point-of-care transthoracic echocardiography (TTE) is integral to the practice of acute care medicine to help assess patients quickly, accurately, and non-invasively. This review discusses how point-of-care TTE works in terms of logistics and diagnostic capabilities, specifying the information available from each point-of-care TTE view. The TTE findings of potentially reversible causes of shock are also described to help distinguish different causes of shock and to guide management and therapeutic interventions. While data have not shown that point-of-care TTE improves patient outcomes or mortality, it can certainly narrow the differential diagnosis for the cause of shock, potentially allowing earlier, more appropriate treatment.
Ejection fraction (EF) is a well accepted and useful index of quantitative left ventricular (LV) function, but it is influenced by changes in preload, afterload, and contractility. Stroke volume (SV) can be obtained with 2D transesophageal echocardiography (TEE) by measuring LV end-systolic and end-diastolic volumes for measuring EF. TEE evaluation of LV systolic function, both global and regional, provides insight into hemodynamic impairment in a variety of situations. Doppler echocardiography is the principal diagnostic tool to assess LV diastolic function non-invasively. TEE facilitates a complete evaluation of diastolic LV function by assessing diastolic phases and elucidating structural causes of altered diastole. The use of this tool has relevant implications in the management of hemodynamic derangement due to impaired diastolic function, in vasoactive drugs titration, in the detection of myocardial ischemia, and in performing prognostic stratification.
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