Point-of-care echocardiography: asking the right questions.

This history of cardiology is replete with examples of changes in clinical care that were driven by the development of new technology. The enormous potential clinical value of electrocardiography became apparent with the development of the early string galvanometers, which were expensive and bulky. However, this potential was realized only when electrocardiographic machines became streamlined, smaller, less expensive and portable. Initially performed only in a laboratory setting, the electrocardiogram is currently used by virtually all physicians — cardiologists and non-cardiologists — and by some non-physicians — emergency medical technicians and coronary care unit nurses — in a variety of settings to evaluate patients with known or suspected heart disease. Echocardiography has replaced electrocardiography as the principal non-invasive cardiac test, and has evolved rapidly over the past few decades. Twodimensional imaging and colour flow Doppler were technologic innovations that fundamentally changed the way we make cardiac diagnoses. Recent improvements in cardiac ultrasound have been both evolutionary and revolutionary. Examples of evolutionary advances include automatic border detection for assessment of systolic function, Doppler tissue imaging for assessment of diastolic function, and harmonic imaging for improved endocardial border definition. One revolutionary advance has been the introduction of true three-dimensional echocardiographic imaging based on planar array technology. Although still in its infancy, this technology, by all accounts, represents the future of cardiac ultrasound. Miniaturization represents the second recent revolutionary advance in echocardiography. Improvements in microcomputer technology have led to the development of ultrasound machines no larger than a laptop computer. These so called ‘point-ofcare’, hand-carried cardiac ultrasound (HCU) devices are capable of generating extremely high quality cardiac images that rival those from standard