Yes. In cases of ADHF from diastolic dysfunction, the process is still the same. Lack of forward cardiac flow secondary to poor cardiac relaxation (unlike systolic dysfunction where the problem is dysfunctional contraction) occurs classically in the elderly, long-term hypertensive patient with an acute elevation of blood pressure. Often, patients will have a mixture of both, and the benefit of the triple scan is that it allows the clinician to visualize this often-complex physiologic principle. In the classic case, the triple scan will show a thickened myocardium (with or without poor systolic cardiac function), B-lines in bilateral lung fields, and a plethoric IVC.
Explore This IssueACEP News: Vol 31 – No 09 – September 2012
Summary and Conclusion
Evaluation of the acutely dyspneic patient in the ED is often challenging. A focused ultrasound examination consisting of bedside echocardiography, limited lung examination, and views of the IVC is a powerful tool that can visually represent the disease pathology. In the case of ADHF, the lack of forward blood flow and its resultant pulmonary congestion can be rapidly defined at the bedside, allowing for initiation of directed therapy and reducing clinical uncertainty. Focused echocardiography will indicate gross poor systolic function. The limited ultrasound exam of the anterior lungs will demonstrate bilateral B-lines/AIS. A patient with ADHF will have poor respirophasic IVC variability. The triple scan in conjunction with a clinical exam can be an ideal tool to rule in or rule out the diagnosis of ADHF.
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