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. 2019 Dec 27;11(1):34.
doi: 10.1186/s13089-019-0149-0.

Cardiac ultrasound in resource-limited settings (CURLS): towards a wider use of basic echo applications in Africa

Michaëla A M Huson  1 , Dan Kaminstein  2 , Daniel Kahn  3 , Sabine Belard  4   5 , Prakash Ganesh  6   7 , Vanessa Kandoole-Kabwere  8 , Claudia Wallrauch  9 , Sam Phiri  6   10   11   12 , Benno Kreuels  8   13 , Tom Heller  14
Affiliations

Cardiac ultrasound in resource-limited settings (CURLS): towards a wider use of basic echo applications in Africa

Michaëla A M Huson et al. Ultrasound J. .

Abstract

Background: Point-of-care ultrasound is increasingly being used as a diagnostic tool in resource-limited settings. The majority of existing ultrasound protocols have been developed and implemented in high-resource settings. In sub-Saharan Africa (SSA), patients with heart failure of various etiologies commonly present late in the disease process, with a similar syndrome of dyspnea, edema and cardiomegaly on chest X-ray. The causes of heart failure in SSA differ from those in high-resource settings. Point-of-care ultrasound has the potential to identify the underlying etiology of heart failure, and lead to targeted therapy. Based on a literature review and weighted score of disease prevalence, diagnostic impact and difficulty in performing the ultrasound, we propose a context-specific cardiac ultrasound protocol to help differentiate patients presenting with heart failure in SSA.

Results: Pericardial effusion, dilated cardiomyopathy, cor pulmonale, mitral valve disease, and left ventricular hypertrophy were identified as target conditions for a focused ultrasound protocol in patients with cardiac failure and cardiomegaly in SSA. By utilizing a simplified 5-question approach with all images obtained from the subxiphoid view, the protocol is suitable for use by health care professionals with limited ultrasound experience.

Conclusions: The "Cardiac ultrasound for resource-limited settings (CURLS)" protocol is a context-specific algorithm designed to aid the clinician in diagnosing the five most clinically relevant etiologies of heart failure and cardiomegaly in SSA. The protocol has the potential to influence treatment decisions in patients who present with clinical signs of heart failure in resource-limited settings outside of the traditional referral institutions.

Keywords: Africa; Cardiac ultrasound; POCUS; Protocol; Resource-limited setting.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Geographic area of the 18 included studies on frequency of causes of cardiac failure. Note that some studies included multiple sites. Therefore, there are more study sites in the figure than included studies
See this image and copyright information in PMC

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