Guiding pulmonary vasodilatory therapy in systemic sclerosis associated pulmonary hypertension using morphology of the right ventricle outflow tract velocity time integral

Systemic sclerosis (SSc) is a chronic, autoimmune disease involving small vessels characterized by skin and internal organs fibrosis. Interstitial lung disease (ILD) is one of the main findings, along with pulmonary hypertension, as a marker of morbidity and mortality. Diagnosis is usually late, and therefore treatment is established in the advanced stages of the disease. Point of care ultrasound (POCUS) emerges as a tool at the bedside for shortening diagnostic times and guiding therapy. Here, we performed a multi-organ POCUS, evidencing the presence of ILD and pulmonary hypertension in a patient with no cardiovascular symptoms suggestive of advanced disease. We did real-time monitoring of pulmonary vasodilator therapy at the patient's bedside using right ventricle outflow tract velocity time integral morphology (RVOT VTI). Midsystolic notching of RVOT VTI is highly specific for pulmonary hypertension. POCUS is a valuable tool that could improve diagnostic times and optimize therapy monitoring in asymptomatic patients with early manifestations of organic involvement in patients with SSc. This case demonstrates the value of POCUS as a follow-up tool in treating patients with SSc.