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

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.