Cardiac EDE Flashcards
Criteria for adequate subxiphoid view
7 sign
inferior pericardium visualized
apex seen
liver
Trouble shooting subxiphoid view
lying down, deep breath and hold it, knees up/flex hips
troubleshooting precordial views
breathing, turn to left lateral decubitus
Sizing a pericardial effusion
<1cm: small, seen inferiorly/posteriorly depending on view
1-2cm: medium sized; can seen circumferentially
>2cm: massive pericardial effusion, seen circumferentially.
differentiating epicardial fat pad from pericardial effusion
MESA
Moves with heart
Echogenic (not just black like an effusion)
Subxiphoid view visualized
Seen more anteriorly.
EF of hyperdynamic heart
70
normal EF
50-70
mild-moderately reduced EF
30-49%
severely reduced EF
<30%
What to look for in global cardiac assessment
LV dilation
Myocardial thickening
Endocardial excursion
E Point septal separation
Assessment of anterior mitral leaflet (LV) to see how it slaps the interventricular septum. Must come within .7cm of the interventricular septum to see if it has normal contractility. If it doesn’t make it remotely close to the septum, the contractility of the LV is likely reduced.
When does E Point Septal Separation (EPSS) overestimate and underestimate EF
Overestimate: mitral stenosis, mitral calcification, aortic regurgitation
Underestimate: off centre measurements, mitral regurgitation, septal hypertrophy, LVH.
Acute and chronic causes of RV Dysfunction
Acute: PE, RV infarction, RV trauma
Chronic: Pulmonary HTN (CHF, OSA, COPD)
valvular insufficiency (TR, PR, PS), cardiomyopathy, ASD.
TF: POCUS can rule out a PE
false. It can help rule in acute PE (Ie, RV strain such as D sign or intraventricular septum deviation), but never rule out
tamponade diagnosis is __, using becks triad.
Clinical
Becks triad; muffled heart sounds, distended JVP, hypotension
A lines are ___ artifact between __ and __. It can be seen in normal aerated lung, but does not mean normal lung.
A lines are REVERBERATION artifact between PLEURA and SKIN. It can be seen in normal aerated lung, but does not mean normal lung.
How do B lines differentiate between comet tails
B lines are deeper
B lines look like __ which go from the pleura to over 15cm deeps. They are ____ with lung movements and ___ A LINES. More than ____ in one intercostal space is abnormal, and indicates ____ in the alveoli.
B lines look like SPOTLIGHTS which go from the pleura to over 15cm deeps. They are SYNCHRONUS with lung movements and OBSCURES A LINES. More than 3 in one intercostal space is abnormal, and indicates FLUID in the alveoli.
ddx for symmetrical vs asymmetric B lines.
symmetrical: CHF/pulmonary edema, fibrosis
Asymmetrical: ARDS, pNA, Pulmonary contusion/hemorrhage, COVID.
COMET TAILS are aka ___ lines
z lines, they are ill defined vertical lines that are short and disappear after 2-4 cm. They do not obscure A lines and move independent of the lung. they are of no clinical significance.
Distinguishing Aorta vs IVC
Aorta: No respiratory variation, No compressibility, Thicker Echogenic wall
Less reliable: orientation, pulsatility.
aorta scan boundaries
visualize the entire aorta from the diaphragm to the bifurcation.
abnormal aorta diameters
aorta >3cm = AAA, aorta <5.5cm = high risk.
Pericardial effusions can be seen in multiple views, with the exception of:
cardiac surgery patietns.d
describe the normal RV in A4c view
traingular in shape
LV 60% of the view
Apex is LV dominant
Thinner wall.
