Nomenclature
A variety of terms are used to describe cardiac point of care cardiac ultrasound, and it is worth knowing some of the differences. In this module, we will cover qualitative and semi-quantitative methods for evaluation of cardiac structure and function.
POCUS involves the use of ultrasound at the bedside by the treating clinician to confirm or refute a diagnosis suspected from the history and physical examination.
Focused Cardiac Ultrasound (FoCUS) – This describes point of care cardiac ultrasound and use of qualitative and semi-quantitative methods for evaluation of cardiac structure and function. FoCUS involves use of 2D imaging, M-Mode and colour doppler.
Focused Assessed Transthoracic Echo (FATE) – The FATE protocol was developed by Dr Erik Sloth in 1989 with the aim of evaluating cardiac function. It is similar to FoCUS, except that the protocol starts with the subcostal 4 chamber view. The Basic FATE protocol includes lung ultrasound. A FATE card is shown below.
Critical Care Echocardiography (CCE) – Echocardiography is increasingly important in the management of critically unwell patient. CCE involves both qualitative and quantitative evaluation of cardiac function, and lies somewhere in between FoCUS or FATE and a consultative TTE.
Consultative Transthoracic Echocardiography – This is a comprehensive ultrasound evaluation performed by cardiac sonographers and evaluated by cardiologists in the echo lab. Both basic and advanced imaging modalities are used to determine cardiac structure and function.
FoCUS vs Transthoracic Echocardiography.
Focused Cardiac Ultrasound (FoCUS) refers to a bedside ultrasound examination of the heart performed by the treating physician. It is typically used to answer a focused clinical question. FoCUS does not replace a ‘limited/targetted echo’ or comprehensive echo’ which allows for a complete assessment of cardiac structure and function. The latter is performed by trained sonographers and interpretated by cardiologists.
Focused Cardiac Ultrasound:
- Qualitative & semi-quantitative study
- Limited Number of Views
- Limited Number of Pathologies
- Simple Equipment / Handheld Ultrasound
- Simple Imaging Modes – 2D / Color Doppler / M-Mode
- Goal Directed
- Performed & Interpreted at the Bedside
Transthoracic Echocardiogram:
- Quantitative Study
- Extensive Knowledge of Pathologies
- All Views Utilized
- Cart Based Ultrasound Machines
- Advanced Imaging Modes – eg Doppler, Tissue Doppler, 3D
- Targeted (Limited Echo) or Comprehensive
- Interpreted in the Echo Lab