Cardiac Ultrasound in Acute Coronary Syndromes

Purpose of Review Acute coronary syndrome (ACS) presents a diagnostic, management, and prognostic challenge to even the most experienced clinicians. The role of cardiac ultrasound in ACS also changes frequently, with two distinct modalities used to assist in diagnosis and management of ACS-transthoracic echocardiography (TTE) and focused cardiac ultrasound (FoCUS). We will review the latest updates in both the cardiology and emergency medicine literature regarding the role of cardiac ultrasound in ACS as well as how to perform basic FoCUS. Recent Findings The American College of Cardiology (ACC) and American Heart Association (AHA) most recent guidelines released in 2014 reaffirm the role of TTE in diagnosis and management of ACS at all stages. FoCUS has been traditionally limited to excluding other causes of suspected ACS ( pulmonary embolism, aortic dissection, cardiac tamponade). However, recent studies have demonstrated that emergency medicine physician-performed FoCUS can evaluate systolic and diastolic function and regional wall motion abnormalities. Summary Cardiac ultrasound in ACS has a myriad of roles with diagnostic, management, and prognostic implications. Both comprehensive TTE performed and interpreted by cardiology and FoCUS performed by the ED clinician have a place in medical decision-making. The current role of FoCUS is to assist in ruling out other causes of suspected ACS. Further research will be needed to delineate if FoCUS can effectively take on more advanced diagnostic and therapeutic roles that are performed by TTE.