Cardiac ultrasound: Difference between revisions

m (Neil.m.young moved page Bedside cardiac ultrasound to Cardiac ultrasound)
No edit summary
Line 1: Line 1:
==Background==
==Background==
*Use phased array probe
*Important to realize that the cardiac ultrasound preset on some machines reverses the indicator marking with the probe indicator on the right
*Important to realize that the cardiac ultrasound preset on some machines reverses the indicator marking with the probe indicator on the right. With the general ED ultrasound the probe indicator is on the left of the screen.
*With the general ED ultrasound the probe indicator is on the left of the screen
 
==Indications==
*[[Shock]]
*[[Chest pain]]
*[[Shortness of breath]]


==Technique==
==Technique==
#Select probe
#*Phased array probe
#Location
[[File:Cardiac Ultrasound.png|250px]]
[[File:Cardiac Ultrasound.png|250px]]
===Parasternal Long===
===Parasternal Long===
*Pointer to the L hip, probe at L 3rd/4th intercostal space adjacent to sternum
*Pointer to the left hip, probe at left 3rd/4th intercostal space adjacent to sternum
*Use to visualize global function and rule out pericardial effusion/tamponade
*Use to visualize global function and rule out pericardial effusion/tamponade
**Can evaluate mitral valve, aortic valve, aortic root, LV squeeze
**Can evaluate mitral valve, aortic valve, aortic root, LV squeeze


===Parasternal Short===
===Parasternal Short===
*Pointer to L shoulder, probe at L 3rd/4th intercostal space adjacent to sternum
*Pointer to left shoulder, probe at left 3rd/4th intercostal space adjacent to sternum
*Tip: obtain parasternal long view, then rotate probe 90 degrees
*Tip: obtain parasternal long view, then rotate probe 90 degrees
*Use to evaluate LV squeeze, R ventricle
*Use to evaluate LV squeeze, right ventricle
**R heart strain = dilated R ventricle  
**Right heart strain = dilated right ventricle  


===Apical 4 chamber===
===Apical 4 chamber===
*Pointer to Right, usually below nipple
*Pointer to right, usually below nipple
*Use to visualize global function (Left and right ventricle, squeeze)  
*Use to visualize global function (Left and right ventricle, squeeze)  


===Subxyphoid===
===Subxyphoid===
*Pointer to Right, subxyphoid with probe pointed toward head
*Pointer to right, subxyphoid with probe pointed toward head
*Use liver to as acoustic window to visualize heart
*Use liver to as acoustic window to visualize heart
[[File:Cardiac Subxyphoid.png|300px]]


===Suprasternal===
===Suprasternal (Optional)===
*Pointer at 12 o'clock (cephalad) and place in sternal notch
*Pointer at 12 o'clock (cephalad) and place in sternal notch
*Move probe inferior and to the left to visualize aortic arch
*Move probe inferior and to the left to visualize aortic arch
Line 31: Line 39:
**Can evaluate for aortic dissections/aneurysms and aortic stenosis/regurg.
**Can evaluate for aortic dissections/aneurysms and aortic stenosis/regurg.


==Measurements==
==Findings==
===Aorta===
*Normal aortic root is <3.8 cm (parasternal view with dot pointing to Lt arm)
 
===Classic Ultrasound Findings For Critically Ill Patients===
===Classic Ultrasound Findings For Critically Ill Patients===
{| class="wikitable sortable"
{| class="wikitable sortable"
Line 55: Line 60:
|}
|}


==Pericardial Effusion==
===Parasternal Long===
*For cardiac tamponade
*Assess for percardial effusion and differentiate from pleural effusions
**Pericardial effusion
*Assess squeeze using E-point septal separation (EPSS)
***In acute cases, even a relatively small build up of pericardial fluid can lead to hemodynamic compromise
**EPSS >7mm is 100% sensitive for EF <30%<ref>McKaigney CJ, Krantz MJ, La Rocque CL, et al. E-point septal separation: a bedside tool for emergency physician assessment of left ventricular ejection fraction. Am J Emerg Med. 2014; 32(6):493-497.</ref>
**Diastolic collapse of the right atrium (in atrial diastole)
 
**Diastolic collapse of the right ventricle
===Parasternal Short===
**Plethoric IVC
*Assess for pericaridal effusion
**Valvular pulsus parodoxus
*Assess for squeeze - visual estimate of hyperdynamic, good, moderate, or poor
***Doppler interrogation across the mitral valve will demonstrate exaggerated respiratory variability of transvalvular flow
 
===Apical 4 chamber===
*Assess RV:LV diameter at the level of the valves
**Normal RV:LV is 0.6:1
**RV strain is >1:1
*Assess for McConnellS sign
 
===Subxyphoid===
*Assess for pericardial effusion
 
===Suprasternal (Optional)===
*Assess for aortic dissection
 
===[[IVC ultrasound]]===
*Tyically included in interpretation
 
==Images==
[[File:Cardiac Subxyphoid.png|300px]]
 
==Pearls and Pitfalls==
 
 
==Documentation==
===Normal Exam===
A bedside ultrasound was conducted to assess the heart with clinical indications of SOB. The parasternal long, parasternal short, apical four chamber, subxyphoid, and IVC views were obtained. Normal diameter AOFT, no pericardial or pleural effusions identified, good squeeze, RV<LV, and IVC was not plethoric nor flat. Normal cardiac ultrasound.
 
===Abnormal Exam===
A bedside ultrasound was conducted to assess the heart with clinical indications of SOB. The parasternal long, parasternal short, apical four chamber, subxyphoid, and IVC views were obtained. Normal diameter AOFT, EPSS >7mm, no pericardial effusion, bilateral pleural effusions, poor squeeze, RV<LV, and IVC was plethoric. Indicative of systolic heart failure.
 
==Clips=


==Video==
==Video==
Line 80: Line 114:
==References==
==References==
<references/>
<references/>
Sonosite
Uptodate


[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Radiology]]
[[Category:Radiology]]
[[Category:Ultrasound]]
[[Category:Ultrasound]]

Revision as of 15:45, 27 February 2017

Background

  • Important to realize that the cardiac ultrasound preset on some machines reverses the indicator marking with the probe indicator on the right
  • With the general ED ultrasound the probe indicator is on the left of the screen

Indications

Technique

  1. Select probe
    • Phased array probe
  2. Location

Cardiac Ultrasound.png

Parasternal Long

  • Pointer to the left hip, probe at left 3rd/4th intercostal space adjacent to sternum
  • Use to visualize global function and rule out pericardial effusion/tamponade
    • Can evaluate mitral valve, aortic valve, aortic root, LV squeeze

Parasternal Short

  • Pointer to left shoulder, probe at left 3rd/4th intercostal space adjacent to sternum
  • Tip: obtain parasternal long view, then rotate probe 90 degrees
  • Use to evaluate LV squeeze, right ventricle
    • Right heart strain = dilated right ventricle

Apical 4 chamber

  • Pointer to right, usually below nipple
  • Use to visualize global function (Left and right ventricle, squeeze)

Subxyphoid

  • Pointer to right, subxyphoid with probe pointed toward head
  • Use liver to as acoustic window to visualize heart

Suprasternal (Optional)

  • Pointer at 12 o'clock (cephalad) and place in sternal notch
  • Move probe inferior and to the left to visualize aortic arch
  • Rotate probe clockwise for further image optimization
    • Can evaluate for aortic dissections/aneurysms and aortic stenosis/regurg.

Findings

Classic Ultrasound Findings For Critically Ill Patients

Disease Cardiac IVC Lung (Phased Array) Lung (Linear)
MI Focal WMA
Mod/Poor squeeze		 ↑ NL or B-lines Sliding
Tamponade RA collapse with filling
RV collapse with filling		 ↑ NL Sliding
pneumothorax NL or Hyperdynamic ↑ Lung point
Consolidated lung		 Absent lung sliding
Sepsis Hyperdynamic squeeze ↓ NL (see pneumonia) Sliding
Pneumonia Hyperdynamic squeeze NL or ↓ Unilateral B-lines Sliding
Decompensated HF Mod/Poor squeeze ↑ Bilateral B-lines Sliding
PE RV > LV
McConnell's sign		 ↑ NL or Unilateral B-lines Sliding

Parasternal Long

  • Assess for percardial effusion and differentiate from pleural effusions
  • Assess squeeze using E-point septal separation (EPSS)
    • EPSS >7mm is 100% sensitive for EF <30%[1]

Parasternal Short

  • Assess for pericaridal effusion
  • Assess for squeeze - visual estimate of hyperdynamic, good, moderate, or poor

Apical 4 chamber

  • Assess RV:LV diameter at the level of the valves
    • Normal RV:LV is 0.6:1
    • RV strain is >1:1
  • Assess for McConnellS sign

Subxyphoid

  • Assess for pericardial effusion

Suprasternal (Optional)

  • Assess for aortic dissection

IVC ultrasound

  • Tyically included in interpretation

Images

Cardiac Subxyphoid.png

Pearls and Pitfalls

Documentation

Normal Exam

A bedside ultrasound was conducted to assess the heart with clinical indications of SOB. The parasternal long, parasternal short, apical four chamber, subxyphoid, and IVC views were obtained. Normal diameter AOFT, no pericardial or pleural effusions identified, good squeeze, RV<LV, and IVC was not plethoric nor flat. Normal cardiac ultrasound.

Abnormal Exam

A bedside ultrasound was conducted to assess the heart with clinical indications of SOB. The parasternal long, parasternal short, apical four chamber, subxyphoid, and IVC views were obtained. Normal diameter AOFT, EPSS >7mm, no pericardial effusion, bilateral pleural effusions, poor squeeze, RV<LV, and IVC was plethoric. Indicative of systolic heart failure.

=Clips

Video

{{#widget:YouTube|id= 4qerzEW_ASU}}

{{#widget:YouTube|id= EaLuCBXXINg}}

{{#widget:YouTube|id= _eHZz-OCc_M}}

{{#widget:YouTube|id= 1UJ6RodOSTw}}

See Also

References

  1. ↑ McKaigney CJ, Krantz MJ, La Rocque CL, et al. E-point septal separation: a bedside tool for emergency physician assessment of left ventricular ejection fraction. Am J Emerg Med. 2014; 32(6):493-497.
Retrieved from "https://www.wikem.org/w/index.php?title=Cardiac_ultrasound&oldid=125088"