Answers in the Palm of Your Hand
The patient had a history of heart failure, and came to the clinic complaining of a seesawing heart rate. There was no possibility of getting an immediate echocardiogram to help with diagnosis.
So Barbara Srichai, MD., a cardiologist at MedStar Georgetown University Hospital, used the new handheld ultrasound device that was in trial at the Heart Clinic. “I saw that the issue was not that bad, and was able to pursue a therapeutic course that otherwise I might have had to wait several days to prescribe,” she recalls.
Welcome to the new world of outpatient cardiac care, where the portability and miniaturization of diagnostic technology is transforming the patient care experience.
“Slowly, all the devices are getting smaller and smaller,” says Dr. Srichai. “Echocardiographic devices are now more like laptop-type machines. These handheld devices, which have dual-sided transducers that optimize images of the heart, bring ultrasound down to something you can put into your pocket. It becomes an adjunct to the physical exam, allowing the clinician to refine the diagnosis and provide the patient more immediate feedback without having to schedule a separate appointment.”
Both Dr. Srichai and her colleague, Carolina Valdiviezo, MD, note the devices at this point do not replace the detail of an echocardiogram. “This is for big issues,” says Dr. Valdiviezo. “You can tell if heart function is normal or abnormal, if the valve is thickened, if someone in the cancer population has fluid around the heart. You can get an idea of stenosis, but you can’t tell if it’s moderate or severe. So in many cases you will still require a full cardiac study.”
The handheld ultrasound devices went into use at the hospital this spring, and Drs. Srichai and Vadiviezo will be studying the efficacy of the device as they begin to implement it in the cardiac clinic. “Is it difficult to train clinicians to use this?” asks Dr. Srichai. “We’ll look at cardiologists and internists who have no echocardiographic capture experience—if you can’t capture the pictures, or if you don’t know what you’re looking at, then this may not be that useful in their exam.”
While the technology is still prohibitively expensive for widespread use in community clinics, Dr. Valdiviezo says many physicians are interested in the potential of handheld ultrasound. “We’ve been reading about this in the literature for years,” she notes. “It could be used to provide access in remote locations. It has the potential to reduce costs. Patients certainly appreciate not having to return for a separate appointment and reduced uncertainty. This is just the beginning, but it’s a very exciting place to be.”