Bedside echocardiography in internal medicine: which key questions and answers for our decision-making?

The advent of portable equipment in the last years has brought ultrasound technology available at patient bedside, giving the opportunity to non-cardiologists to extend cardiac assessment based on physical examination. Bedside echocardiography is a ‘question-driven’ examination, where simple and often dichotomic answers are searched. It is performed using phased-array probes and bidimensional images are visually evaluated to obtain information regarding cardiac size and function, presence of pericardial effusion, gross valvular diseases. Although this approach can not in any case substitute a standard 2D color-doppler echocardiography, bedside echocardiography has been demonstrated to maintain a good diagnostic accuracy when limited to basic questions, even in the hands of short-trained non cardiologist physicians. At present the bedside ultrasound approach is widely used in different settings and focused echocardiography takes part together with US explorations of lung, abdomen and deep veins in an integrated perspective that perfectly fit with the holistic approach of the internist. In this context we address two typical scenarios encountered in the internal medicine divisions -the patient presenting with dyspnea or non-post-traumatic hypotension- showing the main questions we can ask to bedside echocardiography for a rapid identification of the determinants of symptoms and consequently for a therapeutic choice based on more objective evidences.