Can FoCUS Speed Up the Management of Acute Coronary Syndrome in the Emergency Department?

Focused Cardiac Ultrasound (FoCUS) is a targeted bedside imaging modality with an established role in the management of critically ill patients. Acute Coronary Syndrome (ACS) is a common cause of presentation to the Emergency Department (ED), and although electrocardiography (ECG) and cardiac biomarkers are the cornerstones for its diagnosis, FoCUS may facilitate diagnostic evaluation and disposition of patients in different levels of care. Initially, FoCUS plays a crucial diagnostic role through the identification of Regional Wall Motion Abnormalities (RWMAs), enabling direct visualization of the ischemic region and corroboration of ECG findings. Moreover, in patients with ACS complicated by cardiogenic shock, FoCUS is indispensable for determining the extent of ischemia and detecting mechanical complications, including ventricular septal or free wall rupture, or papillary muscle rupture. Likewise, FoCUS aids in the differential diagnosis of patients with ECG abnormalities mimicking ACS. This comprehensive review synthesizes the most recent evidence on the role of FoCUS in accelerating the management of patients with ACS presenting to the ED.