Author + information
- Kanu Chatterjee, MBBS∗ ()
- ↵∗Division of Cardiovascular Medicine, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, E314-4, GH, Iowa City, Iowa 52242-1081
I read with great interest the paper “Handheld Ultrasound Versus Physical Examination in Patients Referred for Transthoracic Echocardiography for a Suspected Cardiac Condition” by Mehta et al. (1) and the editorial comment by Marwick et al. (2) “Handheld Ultrasound: Accurate Diagnosis at a Lower Cost?”.
Handheld ultrasound (HHU) is very useful in clinical diagnosis of suspected cardiac condition, but there are limitations. How can one diagnose Heberden’s angina by HHU? It is necessary to take an adequate history for diagnosis of angina.
Heart failure is a common and potentially lethal condition. Admittedly, HHU can distinguish between heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. However, the prognosis of these patients is related to the severity of heart failure. New York Heart Association (NYHA) functional classification is an accepted method to assess the severity of heart failure. I do not believe that HHU can diagnose NYHA functional class.
I believe that bedside clinical examination is less expensive than transthoracic echocardiography (TTE) or even the HHU device. It can be repeated as frequently as necessary, and it is less expensive than repeated TTE or HHU examination.
I can provide many more examples of limitations and usefulness of both physical examination and imaging studies.
Please note: Dr. Chatterjee passed away between final acceptance and publication of this letter.
- 2015 American College of Cardiology Foundation
- Mehta M.,
- Jacobson T.,
- Peters D.,
- et al.
- Marwick T.H.,
- Chandrashekhar Y.,
- Narula J.