1. Echo in the palm of your hand Anthony DeMaria, MD Chief of Cardiovascular Medicine University of California at San Diego San Diego, CA

2. Handheld machines Echo in the palm of your hand © 2000 SonoSite, Inc

3. Where are we now? Echo in the palm of your hand Echocardiography offers access to intercardiac anatomy and dynamics. Heavy, large, expensive equipment limited usefulness. The diminishing size and cost is expanding who and when can receive it.

4. Machine specs Echo in the palm of your hand SonoSite received FDA 510(k) premarket clearance for the SonoHeart in Dec 1999 5.4 lbs (2.4 kg) $10,000-15,000 2D and Color Power Doppler scan

5. Primary applications Echo in the palm of your hand “I think that there is a value to think of these devices not as echocardiographs but as screening ultrasound devices.” Anthony DeMaria, MD Chief of Cardiovascular Medicine University of California at San Diego San Diego, CA

6. Evolution of use Echo in the palm of your hand Four steps of future use: emergency imaging screening extended physical examination fully portable echo

7. Expanding potential Echo in the palm of your hand “These devices enable us to potentially do ultrasound on more patients than we’ve done before, and enable us to perhaps expand the number of people who are using ultrasound.” Anthony DeMaria, MD Chief of Cardiovascular Medicine University of California at San Diego San Diego, CA

8. Echo in the palm of your hand Stroke distance* at discharge Post AMI mortality rate 1 month5 years > 100% of age-predicted normal0%< 20% < 65% of age-predicted normal18%43% *the systolic velocity integral of blood flow in the aortic arch UK researchers followed 378 patients for 5 years after AMI Trent RJ, Rawles JM. Heart 1999;82:187-191 Stroke-distance and AMI survival

9. Clinical use Echo in the palm of your hand Echoes in the emergency room allows for an increase in diagnostic yield. This potential is furthered by handheld devices. Can you teach people to perform a reasonable ultrasound examination and extract useful information? There is significant improvement with a short educational process.

10. Screening Echo in the palm of your hand Has been used in pre-athletic screening. A Heart for Sports Foundation (http://www.aheartforsports.org/) Size of the device made it possible to screen large number of athletes in a short period of time.

11. Ubiquity Echo in the palm of your hand Technology will make ultrasound more available and easier to use. Expertise and technique are incredibly important. Ultrasound may never be as ubiquitous as ECG for emergency equipment.

12. Echo in the palm of your hand © 2000 SonoSite, Inc