Cardiac ultrasound: Difference between revisions
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**Valvular pulsus parodoxus | **Valvular pulsus parodoxus | ||
***Doppler interrogation across the mitral valve will demonstrate exaggerated respiratory variability of transvalvular flow | ***Doppler interrogation across the mitral valve will demonstrate exaggerated respiratory variability of transvalvular flow | ||
==Video== | |||
{{#widget:YouTube|id= 4qerzEW_ASU}} | |||
{{#widget:YouTube|id= EaLuCBXXINg}} | |||
{{#widget:YouTube|id= _eHZz-OCc_M}} | |||
{{#widget:YouTube|id= 1UJ6RodOSTw}} | |||
==See Also== | ==See Also== |
Revision as of 09:01, 2 November 2015
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. With the general ED ultrasound the probe indicator is on the left of the screen.
Technique
Parasternal Long
- Pointer to the L hip, probe at L 3rd/4th intercostal space adjacent to sternum
- Use to visualize global function and r/o pericardial effusion/tamponade
- Can evaluate mitral valve, aortic valve, aortic root, LV squeeze
Parasternal Short
- Pointer to L shoulder, probe at L 3rd/4th intercostal space adjacent to sternum
- Tip: obtain parasternal long view, then rotate probe 90 degrees
- Use to evaluate LV squeeze, R ventricle
- R heart strain = dilated R 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
- 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.
Measurements
Aorta
- Normal aortic root is <3.8 cm (parasternal view w/ dot pointing to Lt arm)
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 |
PTX | 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 |
Pericardial Effusion
- For cardiac tamponade
- Pericardial effusion
- In acute cases, even a relatively small build up of pericardial fluid can lead to hemodynamic compromise
- Diastolic collapse of the right atrium (in atrial diastole)
- Diastolic collapse of the right ventricle
- Plethoric IVC
- Valvular pulsus parodoxus
- Doppler interrogation across the mitral valve will demonstrate exaggerated respiratory variability of transvalvular flow
- Pericardial effusion
Video
{{#widget:YouTube|id= 4qerzEW_ASU}}
{{#widget:YouTube|id= EaLuCBXXINg}}
{{#widget:YouTube|id= _eHZz-OCc_M}}
{{#widget:YouTube|id= 1UJ6RodOSTw}}
See Also
Source
Sonosite Uptodate