Clinical Diagnosis – ABC CARDIOL

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Editorial

The Use of POCUS in Daily Practice: Are We Really Ready to Use it Efficiently?

Angelo Antunes Salgado et al. Marcos Paulo Lacerda Bernardo

Research on congestion in patients with heart failure (HF) is crucial for clinical management and prognosis of the disease. Congestion (i.e., the accumulation of fluids in the body) is the main cause of hospital admission and readmission of patients with HF, and it is associated with increased mortality. Early detection and identification of the extent of congestion are essential for choosing the most appropriate therapy, preventing complications, and improving prognosis. Clinical signs of congestion may be insufficiently sensitive and specific for the diagnosis and management of patients with HF.

The point-of-care ultrasound (POCUS) is a diagnostic tool that allows immediate and dynamic visualization of ultrasound images. This tool can be used at the bedside to obtain additional clinical information for the physical examination of a specific disease or procedure. The practicality and speed with which images are obtained result in their high use at hospitals for critically ill patients. POCUS has been used in various medical specialties, especially in pulmonary and cardiac ultrasound.

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Artigo Original

Clinical and pathological discrepancies and cardiovascular findings in 409 consecutive autopsies

Aline Fusco Fares et al. Jorge Fares Gislaine Fusco Fares José Antônio Cordeiro … Marcelo Arruda Nakazone Patrícia Maluf Cury

BACKGROUND: Discrepancies between clinical and autopsy diagnoses persists worldwide. OBJECTIVE: We evaluated autopsies in a university hospital in order to assess the accuracy of clinical cardiovascular diagnosis compared to postmortem findings. METHODS: Four hundred nine consecutive autopsies between 2003 and 2006 were analyzed in a tertiary-care hospital in São José do Rio Preto, SP, Brazil. The comparison of clinic-pathological cardiovascular findings was performed using Goldman’s discrepancies classification. RESULTS: Autopsy rate at the hospital was 8%. Cardiovascular causes of death represented 42.8% (175 out of 409 patients) of autopsy diagnoses. In 98 (56%) patients, there were major discrepancies (class I and II), representing a large proportion of misdiagnoses for mesenteric infarction (84.6%), acute myocardial infarction (64.7%), aorta dissection (64.2%), and pulmonary embolism (62.5%). Highest concordance rates were observed in congestive heart failure (59%) and acute ischemic stroke (58.8%). Age, sex, length of stay and the last admission unit at the hospital were not associated with Goldman criteria. CONCLUSION: Clinic-autopsy discrepancies concerning cardiovascular death remain high in Brazil, despite technological resources available. Moreover, our findings reinforce the importance of postmortem examination in contributing to medical care improvement.

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Original Article

Fatal pulmonary embolism in hospitalized patients. Clinical diagnosis versus pathological confirmation

Cláudio Tinoco Mesquita et al. José Laerte Boechat Morandi Júnior Flávia Teixeira Perrone Cláudia da Silva Oliveira … Lavínia J. Barreira Sônia Santos C. A Nascimento Raul Carlos Pareto Júnior Evandro Tinoco Mesquita

OBJECTIVE – To assess the incidence of fatal pulmonary embolism (FPE), the accuracy of clinical diagnosis, and the profile of patients who suffered an FPE in a tertiary University Hospital. METHODS – Analysis of the records of 3,890 autopsies performed at the Department of General Pathology from January 1980 to December 1990. RESULTS – Among the 3,980 autopsies, 109 were cases of clinically suspected FPE; of these, 28 cases of FPE were confirmed. FPE accounted for 114 deaths, with clinical suspicion in 28 cases. The incidence of FPE was 2.86%. No difference in sex distribution was noted. Patients in the 6th decade of life were most affected. The following conditions were more commonly related to FPE: neoplasias (20%) and heart failure (18.5%). The conditions most commonly misdiagnosed as FPE were pulmonary edema (16%), pneumonia (15%) and myocardial infarction (10%). The clinical diagnosis of FPE showed a sensitivity of 25.6%, a specificity of 97.9%, and an accuracy of 95.6%. CONCLUSION – The diagnosis of pulmonary embolism made on clinical grounds still has considerable limitations.

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The Use of POCUS in Daily Practice: Are We Really Ready to Use it Efficiently?

Clinical and pathological discrepancies and cardiovascular findings in 409 consecutive autopsies

Fatal pulmonary embolism in hospitalized patients. Clinical diagnosis versus pathological confirmation

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