i saw a duplicate post in the cardiology forum (of course without the hubbub), and you can view my overall opinion there.
but also, waterski,
i've got to applaud you on your enthusiasm, but i think in this case it may be misplaced. your clinical scenario of acute mitral regurgitation (rather than decompensation of chronic MR) is a good example. the typical presentation is of acute severe pulmonary edema as you are already aware. the mechanisms are most commonly chordal/papillary muscle rupture or endocarditis. now the tricky thing is arriving at the correct diagnosis, which can be challenging even for experienced cardiologists wielding an ECHO machine. as you know, because of rapidly equilibrating high LA pressure, the MR murmur may be short/early or even absent. For the same reason, the MR by color flow doppler on TTE can be a small puff of deceivingly small MR. in this case, someone who does not know what he/she is doing may interpret the ECHO as "mild" MR, critically delaying the diagnosis. The astute clinician should be looking for the clinical pictrure of acute severe pulm edema in the setting of normal systolic function, helped by the appreciation of an S4 in addition to an S3. Severe MR can also be appreciated by PISA, pulmonary vein doppler and of course by TEE, which is the territory of more advanced ECHO training.
so waterski, i agree with you that many clinicians can get to wield a TTE probe and possibly place IABPs. but, the best decision from the patient care standpoint is to call the friendly neighborhood cardiologist. that's what they are there for.
