Bedside chest ultrasound to distinguish heart failure from pneumonia‐related dyspnoea in older COVID‐19 patients

Abstract

Abstract Aims In the older population, acute heart failure is a frequent, life‐threatening complication of COVID‐19 that requires urgent specific care. We aimed to explore the impact of point‐of‐care chest ultrasound (CUS) use in older bedridden inpatients during the COVID‐19 pandemic as a tool to distinguish between cardiogenic pulmonary oedema and isolated viral pneumonia‐related dyspnoea. Methods and results This prospective series included 16 patients aged 75 or older, hospitalized for acute dyspnoea in an acute geriatric unit of a university hospital and testing positive for a SARS‐Cov2 infection. We collected demographic characteristics, medical history, biological screening, clinical symptoms, CUS findings (n = 16) and chest CT‐scan conclusions (n = 14). Mean age was 89 years (77–97). All patients presented asthenia and dyspnoea, 56% complained of coughing and diarrhoea, and 50% had fever. Acute heart failure was clinically suspected in seven patients. At CUS, evidence of heart failure was confirmed in three patients (including one without clinical suspicion); interstitial syndrome was confirmed in 12 patients on CUS vs. 9 patients with CT. Conclusions In older patients with COVID‐19 and acute dyspnoea, the use of point‐of‐care CUS allowed the clinician to quickly rule out heart failure in nearly half of suspected cases while easily identifying virus‐related interstitial syndrome. The use of CUS appears to be suitable for the rapid bedside investigation of dyspnoea in older patients, particularly in the context of the COVID‐19 pandemic.

Keywords

• COVID‐19
• Dyspnoea
• Heart failure
• Aged
• Pneumonia
• Point‐of‐care ultrasound