Focused POCUS for chest pain
This article explores the role of point-of-care ultrasound (POCUS) in the assessment of patients presenting with acute chest pain. Traditionally associated with areas such as abdominal imaging, POCUS is increasingly being used by clinicians in emergency and acute care settings to help identify or exclude several life-threatening causes of chest pain.
The author emphasises that while history taking and clinical assessment remain fundamental, POCUS can improve diagnostic accuracy and accelerate decision making. Conditions in which POCUS may be particularly useful include myocardial infarction (MI), aortic dissection, pneumothorax, pulmonary embolism (PE), pneumonia and pericardial effusion associated with pericarditis.
For suspected MI, focused cardiac ultrasound can identify regional wall motion abnormalities, potentially aiding earlier recognition of coronary artery occlusion. In aortic dissection, POCUS may detect direct signs such as an intimal flap or indirect signs including aortic enlargement and pericardial effusion, although definitive imaging with CT angiography remains essential.
The article highlights evidence that lung ultrasound is highly sensitive for diagnosing pneumothorax, with the presence of a lung point being highly specific. In suspected PE, ultrasound findings such as right ventricular strain, clot visualisation, pleural effusion or deep vein thrombosis can guide urgency and management. Lung ultrasound may also identify features of pneumonia, while detection of a pericardial effusion can influence treatment decisions in pericarditis.
Overall, the article concludes that POCUS is a valuable bedside tool that can expedite diagnosis, support decisions regarding definitive investigations, and improve management of patients with undifferentiated acute chest pain.
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