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Updated: Jul 14, 2026
08:45
Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
Published on: April 18, 2025
Contrast echocardiography in acute chest pain
Colm McCabe1, Girish Dwivedi, Roxy Senior
1Department of Cardiology, Northwick Park Hospital, Harrow, United Kingdom.
Summary
A patient with atypical chest pain was initially treated for acute coronary syndrome. Echocardiography with contrast revealed a pulmonary embolism, leading to a swift recovery and highlighting the diagnostic utility of bedside contrast-enhanced ultrasound.
Area of Science:
- Cardiology
- Radiology
- Emergency Medicine
Background:
- Atypical chest pain and electrocardiogram changes can mimic acute coronary syndrome.
- Early diagnosis of pulmonary embolism is critical for patient outcomes.
Observation:
- A 45-year-old male presented with atypical chest pain and ST-T changes.
- Initial workup included unremarkable arterial blood gases and echocardiography showing right heart dilation.
- Treatment for acute coronary syndrome was initiated due to evidence of myocardial necrosis.
Findings:
- Contrast-enhanced 2-dimensional echocardiography identified a saddle pulmonary embolism.
- Computed tomographic pulmonary angiography confirmed the diagnosis.
- The patient recovered uneventfully after appropriate treatment.
Implications:
- Contrast-enhanced echocardiography is a valuable bedside tool in the emergency department for diagnosing pulmonary embolism in atypical presentations.
- This technique can expedite diagnosis and guide timely treatment, improving patient outcomes.
- It offers a rapid, non-invasive method for evaluating suspected pulmonary embolism when traditional methods are inconclusive.
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