Kato Naoko P, Svantesson Josefine, Johansson Peter, Strömberg Anna, Jaarsma Tiny
Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden.
Capio Primary Care Centre Johannelund, Region Östergötland, Skogslyckegatan 5 B, SE-587 26 Linköping, Sweden.
Eur Heart J Case Rep. 2024 Sep 13;8(10):ytae511. doi: 10.1093/ehjcr/ytae511. eCollection 2024 Oct.
Appropriate assessment of fluid status of patients with heart failure (HF) is challenging in outpatient settings, e.g. primary care, especially among elderly HF patients with multiple comorbidities. The use of handheld ultrasound devices for point-of-care ultrasound (POCUS) has increased.
An 80-year-old male had HF with preserved ejection fraction with New York Heart Association (NYHA) classification II. He had multiple comorbidities including chronic obstructive pulmonary disease and been followed up in both a nurse-led HF clinic and a nurse-led chronic obstructive pulmonary disease clinic in primary care. During a scheduled visit to the nurse-led HF clinic in primary care, he exhibited orthopnoea and moderate leg oedema. A HF nurse, using a handheld ultrasound device (Vscan, GE Healthcare), detected B-lines in the left lung, indicating the presence of fluid in the left lung, and an enlarged and non-varying inferior vena cava (IVC) during the POCUS examination. Based on these results, the HF nurse concluded that the patient was experiencing decompensated HF, rather than a chronic obstructive pulmonary disease exacerbation. As a result, his loop diuretics were promptly increased. The patient and his wife received advice on self-care from the HF nurse and the chronic obstructive pulmonary disease nurses. At a follow-up visit 2 weeks later, his breathlessness and swelling were reduced, with no B-lines or dilated IVC found during the POCUS examination.
The POCUS can be a good decision support tool for not only physicians but also other healthcare professionals to identify worsening HF and to monitor treatment responses in HF patients in primary care settings.
在门诊环境中，如基层医疗，对心力衰竭（HF）患者的液体状态进行恰当评估具有挑战性，尤其是在患有多种合并症的老年HF患者中。床旁超声（POCUS）使用手持超声设备的情况有所增加。
一名80岁男性，射血分数保留的心力衰竭患者，纽约心脏协会（NYHA）分级为II级。他患有多种合并症，包括慢性阻塞性肺疾病，在基层医疗的护士主导的HF诊所和护士主导的慢性阻塞性肺疾病诊所接受随访。在基层医疗中按计划前往护士主导的HF诊所就诊期间，他出现端坐呼吸和中度腿部水肿。一名HF护士使用手持超声设备（Vscan，通用电气医疗集团）在床旁超声检查中检测到左肺有B线，表明左肺存在液体，以及下腔静脉（IVC）扩张且无变化。基于这些结果，HF护士得出结论，该患者正在经历失代偿性HF，而非慢性阻塞性肺疾病加重。因此，迅速增加了他的袢利尿剂剂量。HF护士和慢性阻塞性肺疾病护士向患者及其妻子提供了自我护理建议。在2周后的随访中，他的呼吸急促和肿胀减轻，床旁超声检查未发现B线或IVC扩张。
床旁超声不仅可以成为医生，也可以成为其他医疗保健专业人员的良好决策支持工具，用于识别基层医疗环境中HF患者HF病情恶化并监测治疗反应。
