Echocardiographic and therapeutic profile of chronic insufficient cardiac patients in acute decompensation treated in emergency department

Key Words: Echocardiographic profile- chronic insufficient cardiac- emergency departments Introduction: Chronic cardiac insufficiency (CCI) is a major problem of public health in Tunisia by its frequency and its consequences... [ view full abstract ]

Key Words: Echocardiographic profile- chronic insufficient cardiac- emergency departments
Introduction: Chronic cardiac insufficiency (CCI) is a major problem of public health in Tunisia by its frequency and its consequences in terms of associated diseases and related deaths and by its impact on the whole system of medical care patients frequently present to emergency departments with symptoms and signs of CCI.
Objective: The objective of our study is to define the echocardiographic and therapeutic features of CCI in patients presenting to emergency departments.
Material and methods : This prospective study was carried out in the emergency department over the period of 3 months, involving all the patients who presented with symptoms and signs of CCI in decompensation. All of them benefited on admission from echocardiographic examination performed by a previously trained emergency physician in Doppler echocardiography.
Results: The study involved 62 patients aged 60.8 + 11 years on average. Seventy-five per cent of them were men. Of the patients included in the study, 45% were hypertensives, 41% were diabetics and 25% were suffering from atrial fibrillation. Sixty-six per cent of cases of CCI in this study were of ischemic origin and 20% of primary origin.
Echocardiography performed on admission by an emergency physician yielded the following findings: mean left ventricular telediastolic diameter (TDD) = 64 + 6 mm; mean left ventricular telediastolic volume (TDV) = 163 + 52 ml; mean ejection fraction (EF) = 35.9 + 7%; 63% of patients had restrictive mitral flow. Mean systolic pulmonary arterial pressure was 45 + 13 mmHg. Thirty-two per cent of patients had mitral regurgitation > grade 2.
The study revealed that 70% of patients were on inhibitors of angiotensin converting enzyme, 18% were on receptor antagonists of angiotensin 2 (ARA2), 56% were on beta-blocking agents and 82% were on loop diuretics.
Mean hospital stay in the emergency department was 18 + 6 hours. Nineteen per cent of the patients were referred to the cardiology department, 4% of them were admitted to the intensive care unit and we had 0.5% of deaths in the emergency department.
Conclusion: The prognosis of chronic cardiac insufficiency remains severe despite taking proper therapy.