Hand-carried Ultrasound Devices Research Articles

Focused cardiac ultrasound examination in the emergency and critical care horse: Training for non-specialist veterinarians and evaluation of proficiency.

BackgroundFocused cardiac ultrasound examination (FoCUS) is rapidly emerging for point‐of‐care cardiac assessment using hand‐carried ultrasound (HCU) devices. A specific FoCUS protocol for horses and adequate training guidelines currently are not available.HypothesisTo gain knowledge about the training necessary to become proficient in performing FoCUS using a HCU device.AnimalsThree healthy Warmblood horses were used for practical training of veterinarians and veterinary students in equine focused cardiac ultrasound (eFoCUS).MethodsProspective educational study. An eFoCUS protocol and 1‐day training course were developed. Pre‐ and post‐course written tests were administered to participants to evaluate proficiency in knowledge of echocardiography and echocardiographic pathology. A post‐course practical examination involved performing eFoCUS and storage of representative images. Images were evaluated using an image quality score and compared between participants with some practical experience and participants with no practical experience.ResultsParticipants' knowledge of echocardiography increased significantly. Recognition of echocardiographic pathology pre‐course ranged from 40% to 90% (mean score, 65.7%) and post‐course from 85% to 100% (mean score, 92%). Eighteen of 21 participants were proficient in performing eFoCUS with a median image quality score of 79% (range, 42%‐95%). Image quality did not differ between participants with some practical experience compared to participants with no experience.Conclusions and Clinical ImportanceVeterinarians and veterinary students independent of previous experience can become proficient in performing eFoCUS after completion of a 1‐day training course.

342 Feasibility and Accuracy of Assessing Left Ventricular Systolic Function by Measuring Left Ventricular Ejection Fraction Using a Hand-held Echocardiography Device With an Automated Algorithm

Integration of automated algorithms for left ventricular ejection fraction (LVEF) assessment in hand-carried ultrasound (HCU) devices could permit focussed, point-of-care LVEF assessments by non-specialised staff such as monitoring for left ventricular systolic function, reducing global heart failure burden. Determine accuracy and feasibility of automated LVEF assessment using HCU integrated with a novel, AI assisted automatic single-plane LVEF algorithm (AutoEF). Nineteen patients (sinus rhythm) undergoing clinically indicated echocardiography (including standard LVEF assessments; Vivid E9; optimal image quality), had AutoEF performed within 24hrs (LVivo EF App on Vscan ExtendTM), using an apical four chamber acquisition. AutoEF measures (end-diastolic volume ‘EDV’, end-systolic volume ‘ESV’, LVEF) were compared to standard echocardiographic single-plane LVEF (SPEF) using Bland-Altman, mean differences (absolute ‘#’, relative ‘%’), and to standard 3D-echocardiographic LVEF (cut-off <50%) using receiver operating characteristic (ROC). AutoEF intraobserver reproducibility was also assessed. In the 19 patients (69% male, 55±15yrs LVEF 58±12% range 26%-68%), AutoEF had 95% feasibility (n=18). AutoEF was comparable to SPEF for EDV (Mean Bias ‘MB’ +0.5(-29,+28), 12±8ml#, 12±8%%), ESV (MB +2.8(-19,+25) -9.3±7ml#, 22±18%%), and LVEF (MB -3.8(-21,+14), 7.6±5.9%#, 15±13%%). AutoEF ROC found AUC=0.95 at ≤49% (Sensitivity 100%; Specificity 86%). AutoEF intraobserver mean differences# were 7±8ml (EDV); 4±5ml (ESV), and 1.7±1.2% (LVEF). AutoEF measurement via HCU is highly feasible and reproducible. SPEF and AutoEF were comparable, and ROC analysis suggests HCU AutoEF may allow reliable detection of reduced LVEF in patients with optimal image quality using single plane acquisition. Further investigations should evaluate accuracy when used by non-specialised staff.

Utility of a Bedside Pocket-Sized Ultrasound Device to Promptly Manage Abdominal Pain in the Emergency Department

Introduction: Abdominal pain is a frequent reason for Emergency Department (ED) admission; it amounts for around 5–10% of all ED visits. Early assessment should focus on immediately distinguishing cases of acute abdomen that require urgent surgical intervention. The clinical localization of pain is crucial, suggesting an initial evaluation of the origin of the abdominal pain; however, imaging is often required for final diagnosis. Ultrasound (US) represents a rapid imaging modality that is readily available in the ED and does not involve radiation or contrast agent administration. A new generation of portable, battery-powered, low-cost, hand-carried ultrasound devices have become available recently; these devices can provide immediate diagnostic information in patients presenting with abdominal pain in ED.The aim of the study was to demonstrate the diagnostic usefulness of a bedside pocket-sized ultrasound (BPU) device (Vscan from General Electrics) in non-traumatic patients complaining of acute abdominal pain in a tertiary care university hospital in Italy. Methods: Patients with acute non-traumatic abdominal pain presenting in ED were prospectively enrolled and underwent physical examination, traditional imaging and BPU. Results: A total number of 230 patients with acute non-traumatic abdominal pain were enrolled. Overall agreement between routine standard imaging and BPU turned out to be equal for computed tomography (K=0.3) and traditional ultrasound (K=0.29). Receiver operating characteristics curve (ROC) analysis for diagnostic power of the BPU in comparison with traditional US showed an area under the curve of 0.65, sensitivity and specificity of 87.2% and 42.31% respectively. Conclusions: Emergency use of BPU in patients with non-traumatic abdominal pain demonstrated good diagnostic performance when compared to traditional imaging, with the potential advantage of reducing costs and delay in patient final disposition.

Point-of-care ultrasound with pocket-size devices in emergency department.

Point-of-care ultrasound is a useful tool for clinicians in the management of patients. Particularly in emergency department, the role of point-of-care ultrasound is strongly increasing due to the need for a rapid assessment of critically ill patients and to speed up the diagnostic process. Hand-carried ultrasound devices are particularly useful in emergency setting and allow rapid assessment of patient even in prehospital setting. This article will review the role of point-of-care ultrasonography, performed with pocket-size devices, in the management of patients presenting with acute onset of undifferentiating dyspnea, chest pain, and shock in emergency department.

The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature.

To review the scientific literature pertaining to the use of hand-carried and hand-held ultrasound devices in low- and middle-income countries (LMIC), with a focus on clinical applications, geographical areas of use, the impact on patient management and technical features of the devices used. The electronic databases PubMed and Google Scholar were searched. No language or date restrictions were applied. Case reports and original research describing the use of hand-carried ultrasound devices in LMIC were included if agreed upon as relevant by two-reviewer consensus based on our predefined research questions. A total of 644 articles were found and screened, and 36 manuscripts were included for final review. Twenty-seven studies were original research articles, and nine were case reports. Several reports describe the successful diagnosis and management of difficult, often life-threatening conditions, using hand-carried and hand-held ultrasound. These portable ultrasound devices have also been studied for cardiac screening exams, as well as a rapid triage tool in rural areas and after natural disaster. Most applications focus on obstetrical and abdominal complaints. Portable ultrasound may have an impact on clinical management in up to 70% of all cases. However, no randomised controlled trials have evaluated the impact of ultrasound-guided diagnosis and treatment in resource-constrained settings. The exclusion of articles published in journals not listed in the large databases may have biased our results. Our findings are limited by the lack of higher quality evidence (e.g. controlled trials). Hand-carried and hand-held ultrasound is successfully being used to triage, diagnose and treat patients with a variety of complaints in LMIC. However, the quality of the current evidence is low. There is an urgent need to perform larger clinical trials assessing the impact of hand-carried ultrasound in LMIC.

Diagnosis of Pericardial Effusion with a New Generation Hand-Carried Ultrasound Device in Cardiothoracic Intensive Care Unit Patients

Technological advances introduced hand-carried ultrasound (HCU) imagers in daily clinical workflow providing several benefits such as fast bedside availability and prompt diagnosis. To evaluate the diagnostic yield of a latest generation HCU imager compared to contrast-enhanced multidetector computed tomography (MDCT) for the detection of pericardial effusion (PE) in cardiothoracic intensive care unit (ICU) patients. Thirty-six patients from a cardiothoracic ICU were enrolled to this study irrespective of their underlying disease. All patients were examined with a new generation HCU for the presence of PE. Definite diagnosis of PE was based on findings of MDCT as standard of reference. Statistical analysis was performed using PASW 18. PE was identified in 20 patients by MDCT (prevalence 56%). The HCU examination was carried out technically successfully in all patients. Sensitivity, specificity, positive and negative predictive value of HCU for the diagnosis of PE were 75%, 88%, 88%, and 74%, respectively. HCU provides rapid, practical, reliable, and cost-effective diagnosis of PE in patients on cardiothoracic ICU.

Bedside diagnosis of pleural effusion with a latest generation hand-carried ultrasound device in intensive care patients

Further development established hand-carried ultrasound (HCU) imagers in daily clinical workflow providing several advantages such as fast bedside availability and prompt diagnosis. To evaluate the diagnostic yield of a latest generation HCU imager compared to chest radiography (CR) for the detection of pleural effusion (PE) in intensive care patients. Forty-eight hemithoraces of 24 patients on surgical intensive care units were enrolled in this study. All hemithoraces were evaluated using both HCU and CR. Definite diagnosis of PE was achieved using a high-end ultrasound system as standard of reference. Statistical analysis was performed using 2 × 2 tables and a McNemar test. A P value of <0.05 was considered statistically significant. PE was present in 35 of 48 hemithoraces (73%). The HCU examination was carried out technically successfully in all hemithoraces. Sensitivity and specificity of HCU for the diagnosis of PE was 91% and 100%, respectively, whereas sensitivity and specificity of CR was 74% and 31%, respectively. The difference between HCU and CR was statistically significant with respect to specificity but not sensitivity (P = 0.008 and P = 0.11, respectively). Due to its ease of use and its high diagnostic yield HCU systems of the latest generation constitute a helpful technique for the primary assessment of PE.

Italian Chapter of the International Society of Cardiovascular Ultrasound Expert Consensus Document on Training Requirements for Noncardiologists Using Hand‐Carried Ultrasound Devices

Hand-carried ultrasound devices (HCDs), also named personal use echo, are pocket-size, compact, and battery-equipped echocardiographic systems. They have limited technical capabilities but offer some advantages compared with standard echocardiographic devices due to their simplicity of use, immediate availability at the patient's bedside, transportability, and relatively low cost. Current HCDs are considered as screening tools and are used to complement the physical examination by cardiologists. Many noncardiologic subspecialists, however, have adopted this technologic advancement rapidly raising the concern of an inappropriate use of HCD by health professionals who do not have any specific training. In keeping with the mission of the International Society of Cardiovascular Ultrasound to advance the science and art of cardiovascular ultrasound and encourage the knowledge of this subject, the purpose of this Expert Consensus document is to focus on the training for all health care professionals considering the use of HCD. Accordingly, this paper summarizes general aspects of HCD, such as technical characteristics and clinical indications, and then details the specific training requirements for noncardiologists (i.e., training program, minimum case load, duration, and certification of competence).

Diagnostic value of a hand-carried ultrasound device for free intra-abdominal fluid and organ lacerations in major trauma patients

BackgroundTechnological progress has led to the introduction of hand-carried ultrasound (HCU) imagers in clinical workflow. The aim of this study is to analyse whether examination with a HCU device is...

Bidirectional endovascular treatment for chronic total occlusive lesions of the femoropopliteal arterial segment using a hand-carried ultrasound device and a retrograde microcatheter

Although endovascular therapy for complex lesions in the lower limbs has frequently achieved successful recanalization by improvement of techniques and devices, chronic total occlusion in the femoropopliteal arterial segment still remains a challenge for treatment by endovascular therapy. We investigated the efficacy and safety of endovascular therapy for chronic total occlusion in the femoropopliteal arterial segment guided by a hand-carried ultrasound (HCUS) device and supported by a retrograde microcatheter. We attempted endovascular therapy for chronic total occlusion lesions in the femoropopliteal arterial segment using a protocol involving a dual-access procedure using the HCUS device and a retrograde 2.7F microcatheter from January 2008 to June 2010. We evaluated the success rate, complications, and clinical outcomes, including the ankle-brachial index (ABI) and primary and secondary patency. Success was achieved in 18 of 19 patients (95%), without major complications (only two small hematomas). The HCUS device was useful in reducing the personnel and space requirements, radiation exposure, and the required amount of contrast agent. The retrograde flexible 2.7F microcatheter was also useful in achieving successful recanalization and contributed to reducing puncture-related complications. The ABI was significantly improved, from 0.56 ± 0.12 to 0.81 ± 0.11 at 1 year (P < .01) and this effect remained stable. Primary and secondary patency was 63% and 89%, respectively, at 3 years. HCUS-guided and retrograde 2.7F microcatheter-supported endovascular therapy for chronic total occlusion lesions of the femoropopliteal arterial segment can achieve a favorable clinical outcome without major complications.

Bedside Hand-Carried Ultrasound by Internal Medicine Residents Versus Traditional Clinical Assessment for the Identification of Systolic Dysfunction in Patients Admitted with Decompensated Heart Failure

The rapid detection of left ventricular systolic dysfunction (LVSD) is an important step in the clinical management of patients admitted with acute decompensated heart failure, because it allows the initiation of treatment specific to LVSD and avoidance of contraindicated therapies. The aim of this study was to determine whether internal medicine residents with limited ultrasound training could use hand-carried ultrasound (HCU) to identify LVSD. Fifty patients admitted with acute decompensated heart failure were imaged from the parasternal window at the bedside with an HCU device by residents blinded to all clinical data, who had undergone limited cardiac ultrasound training (20 practice studies). Ejection fraction (EF) on HCU was graded as >40% or <40%. HCU EF and a number of physical exam findings and electrocardiographic and laboratory variables were compared for their ability to predict to formal echocardiographic left ventricular EF. The average formal EF was 32 ± 16% (range, 7%-70%), with 66% of patients having EFs < 40%. The residents' ability to detect an EF < 40% with HCU was excellent (sensitivity, 94%; specificity, 94%; negative predictive value, 88%; positive predictive value, 97%). Binary logistic regression demonstrated that HCU EF was the most powerful predictor of EF < 40%, with minimal additional value from clinical, exam, lab, and electrocardiographic variables. The time interval between clinical assessment and availability of formal echocardiographic results was 22 ± 17 hours. Residents with limited training in cardiac ultrasound were able to identify LVSD in patients with acute decompensated heart failure with superior accuracy compared with clinical, physical exam, lab, and electrocardiographic findings and an average of 22 hours before the results of formal echocardiography were available.

Hand-Carried Ultrasound Devices in Pediatric Cardiology: Clinical Experience with Three Different Devices in 110 Patients

Hand-Carried Ultrasound Devices in Pediatric Cardiology: Clinical Experience with Three Different Devices in 110 Patients

Hand-Carried Ultrasound Devices in Pediatric Cardiology: Clinical Experience with Three Different Devices in 110 Patients

The aims of this study were to determine the usefulness of hand-carried ultrasound devices in pediatric cardiology and to compare the performance of three different hand-carried ultrasound devices in a pediatric cardiology outpatient clinic and intensive care unit. One hundred ten patients (49 male; mean age, 6.4 ± 5.2 years; range 0.1-38 years) with congenital heart defects or innocent heart murmurs were examined using Siemens Acuson P10, Siemens Acuson P50, and Philips CX 50 systems. The quality of images and the accuracy of B-mode measurements were compared with those obtained using a standard echocardiographic system (Philips iE33). Fifty-nine patients were examined with the Siemens Acuson P10, 29 with the Siemens Acuson P50, and 22 with the Philips CX 50 system. There were no significant differences in B-mode measurements. The Acuson P10 system, however, showed significantly lower image quality, with 64.54% of all studies considered of excellent quality compared with 92.83% with the Acuson P50 and 95.52% with the CX 50 (P < .05) and a mean quality score (1 = fair, 5 = excellent) of 3.5 versus 4.57 with the Acuson P50 and 4.86 with the CX 50 (P < .05). This was attributed to the limited capacity for accurate diagnosis in children with body weights < 10 kg and complex heart defects. Hand-carried ultrasound devices represent a valuable alternative to standard echocardiographic systems in pediatric cardiology. In particular, systems including all echocardiographic modalities offer unlimited versatility in outpatient and intensive care.

Echocardiography for the clinician: a practical update

Echocardiography is the mainstay of cardiovascular diagnostics, and is the most performed test for the evaluation of cardiac function. Critical and costly management decisions are based on quantification of left ventricular volumes and ejection fraction. Recent advances in echocardiography, such as microsphere contrast echocardiography for left ventricular opacification and perfusion imaging, three-dimensional transthoracic and trans-oesophageal imaging, strain and tissue Doppler imaging, all contribute to improving accuracy and reproducibility of these important measurements. Such techniques are now routinely available on standard echocardiography equipment in Australian centres for daily use. Hand-carried ultrasound devices have been developed, which are portable, are affordable and offer increased availability of echocardiography to the wider community. Clinicians should be actively encouraged to adopt these technologies to improve the diagnostic quality and reproducability of echocardiography for our patients. This article provides an overview of important recent advances in echocardiographic imaging with an emphasis on their role in clinical practice today.

Ecocardiografia à beira do leito em terapia intensiva: uma realidade ou um sonho distante?

During the last few years, technological development and acquired experience advanced and the echocardiogram has become an important and useful tool in intensive care unit environment. Data obtained from semi quantitative Doppler echocardiography (transthoracic and transesophageal) evaluation has contributed to an appropriate patient monitoring and management. Echocardiography as a diagnostic, prognostic and monitoring method for fluid responsiveness assessment has become available nowadays since hand-carried ultrasound devices are portable and cheaper. Adequate training and development of appropriateness criteria for use of echocardiography in intensive care unit may lead to a standard use as a bedside tool.

1515: Clinical use of Hand-Carried Ultrasound Devices for Ureteral Stone Detection

To evaluate the usefulness of hand-carried ultrasound (HCUS) devices for ureteral stone detection. Between September 2004 and October 2006, HCUS was performed by the author in 64 patients clinically suspected of having ureterolithiasis in the emergency department of an urban teaching hospital. Of the 64 patients, 47 diagnosed to have ureterolithiasis by urologists on a following day were enrolled in this study. The examination was performed by using one of two HCUS devices: LOGIQ BooK XP (GE Medical Systems), SonoSite 180PLUS (SonoSite). At first both of the kidneys were observed with HCUS to evaluate the intrarenal collecting systems. Thereafter, the possible course of the ureter and the bladder were searched to find the stone. The ureteral stone was detected with HCUS in 16 (34%) of the 47 patients. The locations included the ureteropelvic junction (n = 3), the proximal ureter (n = 1) and the ureterovesical junction (n = 12). The bladder was distended in 37 of the 47 patients. The stone was detected in 16 (43%) of the 37 patients. It is helpful to search for a ureteral stone with HCUS for the conformation of ureterolithiasis when the bladder is distended.

Comparison of Hand-Carried Ultrasound Assessment of the Inferior Vena Cava and N-Terminal Pro-Brain Natriuretic Peptide for Predicting Readmission After Hospitalization for Acute Decompensated Heart Failure

We sought to compare the value of serial assessment with hand-carried ultrasound (HCU) of the inferior vena cava (IVC) with brain natriuretic peptide (BNP) to identify patients with acute decompensated heart failure (ADHF) who will be readmitted or seek emergency department treatment after hospital discharge. Congestive heart failure (CHF) is a leading cause for hospitalization and, once hospitalized, patients with CHF frequently are readmitted. To date, no reliable index exists that can be used to predict whether patients with ADHF can be discharged with low readmission likelihood. A total of 75 patients who were admitted with a primary diagnosis of ADHF were followed. All patients were assessed at admission and discharge with the use of routine clinical evaluation, BNP measurement, and HCU evaluation of the IVC by physicians with limited training in ultrasound. During the 30-day follow-up, 31 patients were rehospitalized or presented to the emergency department. Patients who were subsequently readmitted could not be differentiated from those who were not readmitted by their demographics, comorbidities, vital signs, presence of symptoms/signs suggestive of persistent congestion, hospital length of stay, or net volume removal. Routine laboratory tests, including assessment of renal function, also failed to predict readmission with the exception of serum sodium. Although admission BNP was similar in patients readmitted and not readmitted, pre-discharge log-transformed BNP was greater in patients who subsequently were readmitted. Patients who required repeat hospitalization had a larger IVC size on admission as well as at discharge. In addition, patients who were readmitted had persistently plethoric IVCs with lower IVC collapsibility indexes. At discharge, only serum sodium, log-transformed BNP, IVC size, and collapsibility were statistically significant predictors of readmission. This study confirms that, once hospitalized, patients with CHF frequently are readmitted. Bedside evaluation of the IVC with a HCU device at the time of admission and discharge, as well as pre-discharge BNP, identified patients admitted with ADHF who were more likely to be readmitted to the hospital.

Differences according to gender in reporting physical symptoms during echocardiographic screening in healthy teenage athletes

Many studies have suggested that more women then men present with physical symptoms. There is no data available, however, on the differences in reporting of physical symptoms between teenage male and female athletes. Our objective was to evaluate the differences according to gender in physical symptoms in healthy teenage athletes. A total of 1,465 high school athletes, between the ages of 13 and 19 years participated in a mass echocardiographic screening programme for detection of cardiac abnormalities. Screening was conducted using a hand-carried cardiac ultrasound device (OptiGo, Philips). All participants were actively involved in a high school sport programme. Each athlete was required to fill out a questionnaire before the screening. The athletes were asked to report the occurrence of physical symptoms with activity or exercise. A physical examination was not performed during screening. There were 1,031 (70.4%) male and 434 (29.6%) female participants. Significantly more female teenage athletes reported physical symptoms (190/434, 43.8% versus 267/1,031, 25.9%, odds ratio: 2.28, confidence interval: 1.76-2.81, p less than 0.001). Symptoms did not correlate with any echocardiographically identified cardiac abnormalities in either gender. The differences in the reporting of symptoms were significant for all physical symptoms addressed by the questionnaire. There is a high prevalence of reporting physical symptoms in young healthy athletes without any relation to cardiac abnormalities. Young female athletes report physical symptoms nearly twice as often as their male counterparts.

Hand carried echocardiography screening for LV systolic dysfunction in a pulmonary function laboratory☆

Dyspnea is a common indication for pulmonary evaluation but also a common symptom in heart failure. Identification of dyspneic patients with significant LV systolic dysfunction is critical because of high morbidity of untreated heart failure. We sought to determine whether screening patients referred for pulmonary function testing (PFT) using a hand carried ultrasound (HCU) device could identify LV systolic dysfunction. Forty-nine subjects were recruited from a pulmonary function lab to undergo a brief echocardiographic examination by an internist using a HCU device. All subjects also received an examination with a full-featured echocardiogram machine as a gold standard. All subjects with normal PFT had normal LV systolic function. Among subjects with abnormal PFT, 6 (15%) had LV systolic dysfunction and the remainder had normal LV systolic function. No subjects with LV systolic dysfunction by full-featured echocardiograms were missed by the HCU (sensitivity 100%, specificity 95%, negative predictive value 100%, positive predictive value 75%). LV systolic dysfunction is prevalent among patients with pulmonary disease and can be accurately screened for by a physician using a hand carried ultrasound device with subsequent confirmation with complete echocardiography.

Value of a Cardiovascular Limited Ultrasound Examination Using a Hand-Carried Ultrasound Device on Clinical Management in an Outpatient Medical Clinic

Limited ultrasound imaging studies using hand-carried ultrasound devices at the point of care have individually shown feasibility in the detection of carotid atheroma, left ventricular systolic dysfunction, left atrial enlargement, and abdominal aortic aneurysm. To evaluate the utility of a specific cardiovascular limited ultrasound examination (CLUE) designed to detect all 4 entities in patients seen in an outpatient medical clinic. One hundred ninety-six patients underwent coronary heart disease risk stratification by National Cholesterol Education Program guidelines and CLUE with a hand-carried ultrasound device with cardiac and vascular transducers. CLUE included brief imaging of the carotid arteries, the heart, and the intra-abdominal aorta. The prevalence of abnormal CLUE results and their effect on clinical management were tabulated and stratified by coronary heart disease risk class. Patient age (mean +/- SD) was 56 +/- 14 years (range 22 to 95), and 32.1% were at low risk, 30.6% at intermediate risk, and 37.2% at high risk. Of the 196 CLUEs, abnormalities were present in 37.2% (32.7% had carotid atheroma, 3.1% had systolic dysfunction, 6.1% had left atrial enlargement, and 1.0% had abdominal aortic aneurysm) and were related to age, increasing coronary heart disease risk, and male gender. Overall, CLUE resulted in new management recommendations in 20% of patients, primarily in coronary heart disease risk prevention. In patients at intermediate risk or aged 60 to 69 years, CLUE resulted in new recommendations in 39% and 37%, respectively. In conclusion, when applied to a clinic population, brief cardiovascular ultrasound exams frequently demonstrate unsuspected findings that can change management.