ABC Heart Fail Cardiomyop 2023; 3(2): e20230073

Point-of-Care Ultrasound in Acute Heart Failure: Basic Concepts for Clinical Practice

Leticia Kunst , Luiz Claudio Danzmann , Keslly Krauspenhar Cuchinski , João Ricardo Cambruzzi Zimmer

DOI: 10.36660/abchf.20230073

Introduction

Heart failure (HF) is a complex clinical syndrome that promotes a system of poor tissue perfusion in conditions of low cardiac output and elevated filling pressures, resulting in circulatory congestion and hypoperfusion. The exacerbation of this condition is responsible for 40% of consultations due to dyspnea in emergency rooms, and the main cause is worsening congestion due to poor medication adherence. In in-hospital clinical assessment, the most prevalent HF profiles are B (warm and wet) and C (cold and wet), both of which are characterized by circulatory congestion.

Although it causes great demand in the emergency room, it is sometimes difficult to identify signs of hypervolemia in acute decompensated HF in the context of differential diagnosis with other determining syndromes of dyspnea and hypoperfusion. Clinical findings are fundamental for the initial investigation, but objective and rapid confirmation of diagnosis reduces door-to-furosemide time, which is directly related to in-hospital mortality. Natriuretic peptides are tools with high negative predictive value for congestion; however, moderately elevated serum levels represent a diagnostic gray area, as the increase in this marker is related to several diseases that are independent of HF. The use of bedside point-of-care ultrasound (POCUS) has emerged as an excellent tool for comprehensive assessment of this condition, with analysis of cardiac structure and function, the pulmonary interstitium, and some venous vessels. It also offers a rapid, non-invasive, and low-cost opportunity, with greater accuracy than conventional assessment methods for detecting circulatory congestion.

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