Echocardiography Is not a Basic Diagnostic Test
As a specialist in internal medicine/cardiologist, I found it odd that echocardiography is listed as the second item in the list of basic diagnostic tools,
I did not gain clarity about the indication even after reading the entire article. In my opinion, the article does not provide a clinically relevant basis for the diagnostic relevance of echocardiography, anywhere.
For me, as the doctor doing the examinations, this would have been of particular interest since I have already been able to work on requests for transthoracic echocardiography to confirm the presence, or otherwise, of “delirium” in a small department for internal medicine in a specialist psychiatric hospital.
In order to diagnose cardiogenic shock, more sensitive parameters exist, such as blood pressure and pulse rate. Not every infection masks endocarditis. Cardiac decompensation may be present even if the systolic pump function seems normal in the thoracic echocardiography.
How, then, does this diagnostic measure—which means that a patient is moved by strangers from his/her familiar room into an unfamiliar new environment and to a unfamiliar new doctor—ultimately help me with my therapeutic efforts?
Does this not contradict another recommendation in Box 6, namely, that of creating a safe, quiet environment?
In my opinion, the benefits are not in proportion to the harmful effect. Of course it may be said that transthoracic echocardiography is a bedside investigation (such as the EEG), but is this at all realistic?
Dr. med. Jutta Welsch, Rottweil
|1.||Lorenzl S, Füsgen I, Noachtar S: Acute confusional states in the elderly—diagnosis and treatment. Dtsch Arztebl Int 2012; 109(21): 391–400. VOLLTEXT|