Background
Cardiogenic pulmonary edema
Identification of elevated left ventricular filling pressures
Doppler indices | Threshold values | Predicted left ventricular filling pressures | Sensitivity | Specificity | Positive predictive value |
---|---|---|---|---|---|
Sinus rhythm | |||||
Mitral E/A | >2 | >18 mmHgbc
| – | – | 100 % |
Systolic fractiona
| <55 % | >15 mmHg | 91 % | 87 % | – |
<40 % | >18 mmHgbc
| – | – | 55 % | |
≤40 % | ≥18 mmHgbc
| 100 % | 100 % | 100 % | |
≤44 % | >18 mmHgbc
| 85 % | 88 % | – | |
D wave DT | <175 ms | ≥18 mmHgb
| 100 % | 94 % | – |
E/E’ | >15 | >15 mmHgc
| 86 % | 88 % | – |
>7 | ≥13 mmHgbc
| 86 % | 92 % | – | |
>7.5 | ≥15 mmHgbc
| 86 % | 81 % | – | |
>9.5 | >18 mmHgbc
| 100 % | 86 % | – | |
E/Vp | >2 | ≥13 mmHgbc
| – | – | – |
>2.6 | >18 mmHgbc
| 100 % | 86 % | – | |
Atrial fibrillation | |||||
E wave DT | <150 ms | 15 mmHg | 71 % | 100 % | – |
<120 ms | ≥20 mmHg | 100 % | 96 % | – | |
D wave DT | >220 ms | ≤12 mmHg | 100 % | 100 % | – |
E/E’ | >10 | ≥15 mmHg | 75 % | 93 % | – |
E/Vp | ≥1.4 | >15 mmHg | 71 % | 88 % | – |
Diagnosis of the underlying heart disease
Associated lung and pleural changes depicted by chest ultrasonography
Normal lung | Pneumothorax | Interstitial syndrome | Pulmonary edemaa
| Pneumonia | Pulmonary embolism | Fibrosis | Lymphangitis | |
---|---|---|---|---|---|---|---|---|
A-lines | Present | Present or absent | Absent | Absent | Absent | Present when central pulmonary embolism | Absent | Absent or present |
B-lines | Absent except rare B line in lower intercostal spaces | Rules out pneumothorax | Present proportional with interstitial syndrome intensity | Present +++ | Present ++ | Absent | Present | Present |
Condensation | Absent | Absent | Absent | Present in case of massive edema | Present +++ except when pneumonia not in contact with pleura | Subpleural condensation in case of peripheral infarct | Absent | Absent |
Lung sliding | Present | When present rules out pneumothorax | Present | Present | Present | Absent or present | Absent or present | Absent or present |
Lung point | Absent | Pathognomic of pneumothorax | Absent | Absent | Absent | Absent | Absent | Absent |
Pleural effusion | Absent | Absent | Absent | Might be present | Present+ | Might be present | Absent | Might be present |