Sob in Heart Failure

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    Sob in Heart Failure

    A 64 yo male with a history of CHF and COPD arrives with a complaint of acute onset SOB since this morning.  Lung exam is notable for diffuse Rhonchi.  You believe the patient is having a CHF exacerbation, but you’re also concerned for COPD (as well as the multitude of other pathologies that can give you SOB) given the history.  In addition to your standard labs and chest X ray what else might you think to do to evaluate for CHF?

    Lung Ultrasound!

    Especially in our critical care areas, we have ultrasound readily available to us and it turns out that it can be a very useful adjunct when trying to evaluate for acute decompensated heart failure.  The bilateral presence of at least 2 lung zones with at least 3 B-lines is the method by which we evaluate for CHF on POC US.  The study below (along with a review of said study) proposes that lung ultrasound with clinical assessment would have a higher diagnostic accuracy than standard work up in differentiating Acute Decompensated Heart Failure from non-cardiogenic causes of dyspnea.  The study found that the lung ultrasound implemented approach was more accurate (sensitivity 97%, specificity, 97.4%) than the initial clinical workup alone (sensitivity 85.3%, specificity 90%), and chest radiography alone (sensitivity 69.5%, specificity 82.1%).  Additionally, the positive and negative predictive values for the lung ultrasound implemented approach were both 97% – for Lung ultrasound alone they were both 92% (better than CXR alone which had negative and positive predictive values of 76% and 77% respectively).

    http://journal.publications.chestnet.org/article.aspx?articleid=2108968&resultClick=3

    http://www.jwatch.org/na38504/2015/07/10/lung-ultrasound-outperforms-chest-x-ray-diagnosing

     

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