Demonstration of Ultrasound Competency for Hypertrophic Cardiac Abnormalities in Pediatric Patients

Objectives: Hypertrophic Cardiomyopathy (HCM) is an inherited disorder characterized by thickening of the left ventricular wall. In some cases, thickening of the interventricular septum against the motion of the mitral valve leads to impedance of the left ventricular outflow tract, also known as Hypertrophic Obstructive Cardiomyopathy (HOCM). This can result in sudden cardiac death. HOCM can be considered a "silent killer" in children, especially young athletes, as its presence is often subclinical and likely goes undetected and underreported. Point of care ultrasound (POCUS) is an efficient imaging modality that can diagnose HOCM in the pediatric population. We propose that 2nd and 3rd year medical students, all of whom are novice ultrasound users, are able to correctly visualize and measure the interventricular septum in pediatric patients using hand-held portable probes. This is relevant because it highlights the potential for medical students to use POCUS as a screening tool for HOCM. Methods: To evaluate our hypothesis, a group of nine 2nd and 3rd year medical students were asked to perform cardiac ultrasounds on pediatric patients during a pre-participation school sports physical event. While the students had some experience using point of care ultrasound, all were still considered novice ultrasound users. Prior to the event, the students attended a brief cardiac ultrasound training session with faculty. Following the school physical event, the student's images were evaluated by ultrasound-trained faculty members. Using a standardized rubric, the images were graded as either adequate or inadequate. No medical decisions were made during the process and the students were not diagnosing hypertrophic cardiomyopathy or any other heart defects. Results: While we are still in the data analysis phase of our project, preliminary results suggest that medical students are capable of visualizing the interventricular septum using hand-held portable ultrasounds. We aim to have all images evaluated by faculty within the next month. Conclusion: Overall, our project aims to show that medical students can effectively operate hand-held ultrasounds and identify the structures involved in hypertrophic cardiomyopathy. We hope to show that with minimal ultrasound training, both clinical and pre-clinical medical students can obtain cardiac ultrasound images. Our research further highlights the growing importance of point of care ultrasound and its future applications as a potential screening tool for HCM/HOCM during the physical exam.