In this case, the EP performing the ultrasound exam
rapidly detected the presence of a tricuspid valve with an
obviously abnormal finding. Because of the large size of
the right atrium in relation to the right ventricle, tricuspid
valvular incompetence was suspected. Color flow
Doppler imaging was then used to evaluate the valve
and confirmed the presence of tricuspid regurgitation.
The presence of a large valvular vegetation and the
associated tricuspid regurgitation gave the patient a
more ominous prognosis and prompted more aggressive
ED resuscitation and treatment. While EPs with additional
ultrasound training may decide to initiate therapy and
obtain consultations more rapidly based on their bedside
EUS, it is generally advisable to obtain confirmatory
testing as a routine part of the patient's treatment course.
Furthermore, as TTE may not detect all cases of IE, if the
clinical suspicion remains high, hospital admission for
blood culture testing and comprehensive echocardiography
(including possible TEE) remains the prudent
course.