3 - Cardiac US

Question 1

gold standard for cardiac abnormals?

Answer 1

Echocardiography

Question 2

Focused cardiac US?

Answer 2

Not to replace echo

Only to answer specific questions not detect all cardiac pathology

Question 3

Ideal diagnostic tool for detecting life threatening cardiac conditons?

Answer 3

Focused transthoracic echocardiography

Question 4

Primary indications for focused cardiac US?

Answer 4

• Cardiac arrest
• Pericardial effusion/tamponade
• Massive PE
• L ventricular structure and function
• Volume status and fluid responsiveness
• Unexplained HOTN
• Guidance of emergency cardiac pacing

Question 5

Other Indications for cardiac US?

Answer 5

• Valvular abnormalities
• Proximal aortic dissection
• Myocardial ischemia and infarction

Question 6

Basic goals of POC cardiac US?

Answer 6

• ID moderate/large PE
• ID gross cardiac activity or cardiac standstill
• Assess relative and gross chamber size
• Assess ejection fraction (2D estimate)
• Measure E-point septal separation (estimate ejection fx)
• Evaluate gross valvular motion
• Assess volume status by IVC size and collapsibility

Question 7

Most useful view for POC cardiac US?

Answer 7

Subcostal views

Question 8

Does scanning from the subcostal window interfere in resuscitative measures?

Answer 8

Nope

Doesnt interfere w

• thoracostomy
• CPR
• Subclavian line insertion
• ET intubation

Question 9

Ways to improve subcostal 4 chamber view?

Answer 9

• more US gel
• more shallow angle
• move transducer to R to use Liver as window
• move off xiphoid and over lower intercostal space (barrel chested pt)

Question 10

4 chamber view pics

Answer 10

Sized 12 - 15

Question 11

How do you get a parasternal long-axis view?

Answer 11

Aligning the US plane aw the long axis of the L ventricle

• place transducer perpendicular to the chest wall at the 3rd or 4th intercostal space immediately to the left of the sternum w the transducer indicator directed to L hip

Question 12

What can the parasternal long-axis view show you?

Answer 12

• R ventricular free wall
• R ventricular cavity
• Intraventrcular septum (IVS)
• L ventricular cavity
• Posterior L ventricular free wall

Prob will also see

• aortic and mitral valve
• proximal aorta
• L atrium

Question 13

Parasternal long axis pics

Answer 13

18-23

Question 14

What is the imaging plane for parasternal short-axis view?

Answer 14

Toward the R hip

3rd or 4th intercostal space (just L of sternum)

Question 15

Where do you perform a parasternal short axis view?

Answer 15

Base of the heart (aortic valve level)
Level of mitral valve
Level of papillary muscles
Apex

Question 16

Parasternal short axis pics

Answer 16

26-32

Question 17

What is the apical 4 chamber view?

Answer 17

Cornal view of the heart that visualizes all 4 chambers in one plane

Question 18

How to get a 4 chamber view?

Answer 18

Put pt in left lateral decubitus (if possible)

• Place transducer at PIM on L lateral chest wall

Question 19

What does the apical 4 chamber view show

Answer 19

Advantageous for assessing L ventricular function and relative camber size
(L ventricle > R ventricle)

Question 20

Apex 4 chamber pics

Answer 20

35-41

Question 21

What is the IVC view?

Answer 21

Proximal IV (inferior Venal Cava) is the subcostal midline sagittal view as it courses posterior to the liver into the R atrium

Question 22

What does the proximal IVC view give you?

Answer 22

Allows evaluation of the proximal IVC during expiration and inspiration

Question 23

IVC view, normal (low) right sided filling pressure?

Answer 23

IVC view, collapse of > 50% during inspiration

Question 24

IVC view pics

Answer 24

43-48

Question 25

What do you call an argentinian with a rubber toe?

Answer 25

Roberto