TY - JOUR T1 - How to recognise an LV thrombus when you see one: a review of cardiac point-of-care ultrasound JF - Emergency Medicine Journal JO - Emerg Med J SP - 867 LP - 870 DO - 10.1136/emermed-2021-211210 VL - 39 IS - 11 AU - Eric Tam AU - Sally Graglia Y1 - 2022/11/01 UR - http://emj.bmj.com/content/39/11/867.abstract N2 - 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.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 … ER -