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Handheld ECG: stethoscope of the future

In hospitals and clinics of the future, small handheld echocardiography machines will be used to quickly screen patients’ hearts for structural abnormalities. The smaller machines can detect heart abnormalities needing further attention, even when used by physicians with just minimal training, says Dr. John Alexander, based on the results of his new study at Duke University.//

For years, cardiologists have recommended that patients with suspected heart disease undergo hour-long standard echocardiography exams which use sound waves to provide moving pictures of the heart.In the past few years, miniaturisation has reduced these echocardiography systems to the size of a laptop computer.

For their study, the Duke researchers recruited Duke second-year medical residents and cardiology fellows who had no prior experience with echocardiography and gave them three hours of point-of-care echo (POCE) training.They were then asked to perform POCE exams on patinets who had just undergone or were about to undergo a standard echocardiography exam.

The researchers then compared the results of the POCE studies to the standard echocardiography findings on four major heart abnormalities: left ventricular ejection fraction (the strength of the heart’s major pumping chamber); pericardial effusion (fluid in the sac surrounding the heart) mitral regurgitation (leaking of one of the major heart valves); and aortic valvular thickening (thickening of another major heart valve).The results were most positive with the first two abnormalities. It was found that clinicians with limited echocardiography training can use POCE to resonably detect left ventricular dysfunction and pericardial effusion.

Low ejection fraction is an important indicator of heart health. For patients who might come to their doctor with shortness of breath, a quick POCE could determine if there was indeed a low ejection fraction. A stethoscope cannot realiably detect these abn ormalities.While POCE with minimal training was not as accurate in detecting mitral regurgitation or thickening of the aortic valve, Alexander did say that this would improve with additional training. POCE shouldn’t be seen as a replacement for standard echocardiography, which will always have its place in answering important questions about the heart. As a screening tool, however, POCE could play an important role in quickly determining which patients should be sent on for further echocardiography testing.


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