title: A comparison by medicine residents of physical examination versus hand-carried ultrasound for estimation of right atrial pressure.
abstract: Physicians' ability to accurately estimate right atrial (RA) pressure from bedside evaluation of the jugular venous waveform is poor, particularly when performed by physicians in training. Conventional ultrasound measurement of the inferior vena cava (IVC) accurately predicts RA pressure, but the cost, lack of portability, and specialized training required to acquire and interpret the data render this modality impractical for routine clinical use. The objective of this study was to compare physical examination with hand-carried ultrasound (HCU) in the detection of elevated RA pressure (>10 mm Hg). After limited training (4 hours didactic and 20 studies), 4 internal medicine residents using an HCU device estimated RA pressure from images of the IVC in 40 consecutive patients <1 hour after right-sided cardiac catheterization. RA pressure was also estimated from examination of the jugular venous pulse (JVP) in 40 patients before right-sided cardiac catheterization. RA pressure was successfully estimated from HCU images of the IVC in 90% of patients, compared with 63% from JVP examination. The sensitivity for predicting RA pressure >10 mm Hg was 82% with HCU and 14% from JVP inspection. Specificities were similar between the techniques. Overall accuracies were 71% using HCU and 60% with JVP assessment. In conclusion, internal medicine residents with brief training in echocardiography can more frequently and more accurately predict elevated RA pressure using HCU measurements of the IVC than with physical examination of the JVP.
authors.affiliation: The University of Chicago, Illinois, USA.
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Brennan
authors.forename: John E
authors.initials: JE
authors.lastname: Blair
authors.forename: Sascha
authors.initials: S
authors.lastname: Goonewardena
authors.forename: Adam
authors.initials: A
authors.lastname: Ronan
authors.forename: Dipak
authors.initials: D
authors.lastname: Shah
authors.forename: Samip
authors.initials: S
authors.lastname: Vasaiwala
authors.forename: Erica
authors.initials: E
authors.lastname: Brooks
authors.forename: Ari
authors.initials: A
authors.lastname: Levy
authors.forename: James N
authors.initials: JN
authors.lastname: Kirkpatrick
authors.forename: Kirk T
authors.initials: KT
authors.lastname: Spencer
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001830:Body Surface Area; D006328:Cardiac Catheterization; D002641:Chicago; D004867:Equipment Design; D005188:False Negative Reactions; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006339:Heart Rate; D006801:Humans; D007396:Internship and Residency; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D019095:Point-of-Care Systems; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging