Ecocardiograma na avaliação da dor torácica na área de emergência.

Transthoracic echocardiography for the evaluation of chest pain in the emergency department

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Considering the observations that RWMAs are an early sign of myocardial ischemia and that the absence of RWMAs effectively rules out ischemia, a group of investigators prospectively studied the utility of echocardiography in the triage of patients with chest pain [5]. Among 180 consecutive patients presenting to the emergency department at an academic hospital who met inclusion criteria, 94 percent had adequate echocardiograms. Sixty of 169 (36 percent) had no regional or global dysfunction and 22 (13 percent) had global hypokinesis without RWMAs. The following results were noted:

●Of the 88 patients without RWMAs, only 2 (2 percent) subsequently “ruled in” for a non-Q wave myocardial infarction by cardiac enzymes, without clinical sequelae (figure 2).

 

●Of the 87 patients with RWMAs, 27 (31 percent) had an acute myocardial infarction. The initial ECG was diagnostic (ST elevation with or without Q waves) in nine of these patients, and eight had an electrocardiogram that was not interpretable for an acute MI (due to LBBB, pacing, or left ventricular hypertrophy with strain). Thirteen patients subsequently developed pathologic Q waves.

 

Thus, one strategy for screening chest pain patients for RWMAs with echocardiography would be as follows.

●If an adequate echocardiogram can be obtained and there are no RWMAs, it is relative safe to discharge the patient from the emergency department.

 

●Patients with RWMAs should be admitted for further observation and treatment. Those patients with a suspicious chest pain syndrome in whom an adequate echocardiogram cannot be obtained would also warrant observation.

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Muito bom acertar em 96% dos casos com o ecocardiograma no pronto socorro.

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