Point-of-care ultrasound in acute coronary syndrome–it’s about time

Acute coronary syndrome (ACS) is a medical emergency that requires immediate recognition and therapy. Despite major advances in the acute pharmacologic and interventional care of myocardial infarction in the past decades, surprisingly little has been added to pre-intervention risk stratification of ACS, which in essence still utilizes patient risk factors, electrocardiographic features, and cardiac enzyme analysis. Similarly, no changes have occurred in prognostication using bedside physical findings since the Killip score in 1967 [1], which incorporated gallops, rales, and jugular venous pressure. Newer TIMI, GRACE, and HEART scores [2], commonly taught for risk stratification, must all await laboratory data to be fully computed—potentially representing a delay for patient care and disposition. Particularly now with newer technologies available for these patients, an early prognostic marker, particularly on a patient who initially appears stable, could result in urgent mobilization of the cardiac catheterization lab, disposition to the intensive care unit, or transfer to an institution for high-risk revascularization. Time is muscle. …