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SONO case series: how to recognise an LV thrombus when you see one, a review of cardiac point-of-care ultrasound
  1. Eric Tam1,
  2. Sally Graglia2
  1. 1Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
  2. 2Emergency Medicine, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Eric Tam, Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA 94110, USA; Eric.Tam2{at}ucsf.edu

https://doi.org/10.1136/emermed-2021-211210

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    Case presentation

    A 47-year-old man presents to the ED with shortness of breath and chest pain. The shortness of breath has been progressively worsening in the setting of running out of his medications 3 days prior, while the chest pain started after smoking methamphetamines the day prior to presentation. He denies any fevers, new cough, sputum production or sick contacts. He has a 20-year history of daily methamphetamine use. His medical history is notable for heart failure with a reduced ejection fraction (HFrEF) of 20%, type 2 diabetes, coronary artery disease (CAD), untreated deep vein thrombosis and depression. His prescribed medications include furosemide, carvedilol, lisinopril, atorvastatin, metformin and aspirin.

    On physical examination, the patient has a BP of 118/83 mm Hg, HR of 121, temperature of 36.4°C, RR of 22, and an oxygen saturation of 100% on 11 L with a non-rebreather mask.

    He is non-toxic appearing, but in clear respiratory distress with tachypnoea and increased work of breathing. His pulmonary examination is notable for crackles at the bases. Cardiac examination is notable for tachycardia without murmurs, rubs or gallops. His abdomen is soft but protuberant. Lower extremities are warm and well perfused with 2+ pitting oedema from the ankle to the mid-shin, bilaterally.

    Intravenous access is obtained; blood is obtained and sent for processing. A point-of-care ultrasound (POCUS) is performed.

    What are the indications for performing a cardiac POCUS?

    In patients with known heart failure and physical signs of volume overload, POCUS can help confirm the diagnosis of a heart failure exacerbation, exonerate the presence of other pathology and assist in the assessment of volume status. Intravascular volume status may be assessed by left ventricle (LV) size, ventricular function, inferior vena cava (IVC) size and change with respiration.1 2 In addition to assessing systolic function, POCUS can also assess for the presence of a pericardial effusion and right heart strain. Other …

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    Footnotes

    • Handling editor Simon Carley

    • Contributors ET conceived of the article, curated the images, and wrote and edited the article; while SG also wrote and edited the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.