Cardiac Exam DM Flashcards
What are the five cardiac contours? which ones are on the left and which are on the right?
- There are 7 identifiable contours on the frontal cxr. Five most important are- Ascending Aorta (AA), indent on right of potential space of left atrium, Aortic Knob (AK) (shadow caused by the aortic arch), Main pulmonary artery, and concavity of left atrium on the left, left ventricle.
- On the left side we have the aortic knob which is looking at the aorta as it is looping from ascending to descending and you are looking at it on profile; the main pulmonary artery, another notch or indentation between the atrium and ventricle, although we do not see the atrium, we do see the left ventricle.
- On the right side we have the Ascending aorta, a notch between the ascending aorta where the left atrium would be seen if there was LAE, and then the right atrium. If right ventricular artery cannot see it in upright chest xray
What are the cardiac contour shapes describe them and state some changes you can see in different etiologies?
- •Right side
- •Striaghttop line on the right side- The ascending aorta is almost a straight edge visible to the right of the trachea, is also representative of the size of the vena cava and brachiocephalic vessels as well as aorta, white arrow; can either be small or large depending on underlying pathology such as Atrial septal defect (ASD)- small; or aortic stenosis, regurgitation- large; So if you have a good AP/PA projection with no rotation, then the aorta such not extend beyond the right heart border.
- •Right side black arrow is a sign oftwo shadows, w/second bolder shadow that starts in the middle of the first one. First line of the shadow and anotherline w/in second shadow. If you cant see that first line it is double density suggesting left atrium enlarged and encroaching on that right shadow superimposing it
- •Left side:
- •Aortic Knob- is not an anatomic structure, is only seen on xray, formed by the aortic arch.
- •Main pulmonary artery- closed black arrow- white whispystuff, you know it is the pulmonary artery by the vessels that come off it. Show in later slide. Measure the pulmon. Artery in later slide
- •Left atrium indentation- should be indented or curved in slightlyconcave , may not be in left atrial enlargement, if convex or straight. Open arrow is the right atrium, which will almost never enlarge without enlargement of right ventricle.Leftatrium indentation- LAE- Enlargementstraight or bulged out a bit. Systemic resistance, stenosedheart valve, and hypertension causing after the ventricle adjusts to it
- •Last contour is the left ventricle
Cardiac contours. A, Cardiac contours, right side of heart. The first contour is a low-density, almost straight edge visible just to the right of the trachea reflecting the size of the ascending aorta (closed white arrow). Where the contour of the ascending aorta meets the contour of the right atrium, there is usually a slight indentation (closed black arrow). The right heart border is formed by the right atrium (open white arrow). In an adult, the right atrium will almost never enlarge without concomitant enlargement of the right ventricle. B, Cardiac contours, left side of heart. The first contour on the left side of the heart is the aortic knob (closed white arrow). The aortic knob is a radiographic structure formed by the foreshortened aortic arch superimposed on a portion of the proximal descending aorta. The next contour below the aortic knob is the main pulmonary artery (closed black arrow). This is the shadow of the pulmonary artery before it divides into a right and left pulmonary artery. Just below the main pulmonary artery segment there is normally a slight indentation (open white arrow). The last contour of the heart on the left is formed by the left ventricle (open black arrow). The descending aorta almost disappears with the shadow of the spine (dotted black arrows).
What is this?
what has caused it?
what makes it problematic?
Enlarged ascending aorta caused by aortic stenosis. You can see how the aorta extends beyond the shadow of the right atrium.If there is valvularstenosis, there will be post-stenoticdilation. Due to increased pressure to push the blood through the valve will put on wall of the blood vessel weakening and stretching. Ascending aorta should never extend more laterally than this right heart border?
enlargedd ascending aorta in aortic stenosis. The normal ascending aorta should never project farther to the right than the right heart border (closed white arrow) on a nonrotatedfrontal radiograph. In this patient, the ascending aorta (open white arrow) does project farther to the right than it should (the patient also has a scoliosis, which accentuates the prominence slightly). This patient had aortic stenosis. The prominence of the ascending aorta is due to poststenoticdilatation, characteristically seen just distal to hemodynamicallysignificant stenosesin major arteries.
What is it called? What is wrong with this and what dos it indicate?
Double density
If a pt has an enlarged left atrium, you may be able to see a double density at the level of the notch between the aorta and right atrium, one density being the left atrium and the other being the right atrium. usually caused by systemic hypertension.
Looking at more white part of the image (denser whiter) tissue on the outside less dense than inside tissue. Extra extension suggests one part of heart is larger than the rest of that border aka LAE.
Normal is straight line overlapped appearing more dense, if larger than will be stretched out when diverging and less dense in between displacing the right atrium. Back end of arrow closer to it on the right is the inner margin.
“Double density” of left atrial enlargement. In patients with an enlarged left atrium, the right lateral wall of the enlarged left atrium may produce one of two overlapping densities at the junction between the ascending aorta and the right atrium (open white arrow). One of the densities is the normal right atrium (closed white arrow). The other overlapping density is abnormal and represents the enlarged left atrium (closed black arrows).
How do you measure this structure?
Measuring the aortic knob- should be less than 35 mm; measure from the lateral border of air in the trachea to the lateral border of the aorta.
Picture on right Sideways- bad descending aorta, enlarged, plaque. Abdominalxrshows an aorta that is increased in density, due to calcification
If it is more than 35 mm, could be due to increased pressure, flow, or changes in the elasticity of the walls of the aorta- like calcification of the aorta changing pressures
Causes by: Post-stenoticdiliation, aneurysms, calcification,
Measuring the size of the aortic knob. In normal subjects, the aortic knob measures less than 35 mm (black line) from the lateral border of the air in the trachea (open black arrow) to the lateral border of the aortic knob (closed white arrows). The knob can be greater than 35 mm when there is increased pressure, increased flow, or changes in the elasticity of the aortic wall such as might occur in cystic medial necrosis or atherosclerosis.
What is this? how do you find it? how do you measure it? what is considered abnormal?
Pulmonary artery (bump) with pulmonary vessels(branches off of it) adjacent to it. Locating the main pulmonary artery. An assessment of the size of the main pulmonary artery is the keystone of this system, so it is very important for you to know how to find it, no matter what the shape of the heart. You can find the main pulmonary artery (closed black arrows) by finding the adjacent “squiggly” vessels that represent branches of the left pulmonary artery (closed white arrows). These branches of the left pulmonary artery are always immediate next door neighbors to the main pulmonary artery.
Measuring enlargement is a relative measurement drawing tangent line between apex of the heartand aortic knob and it should not extend beyond that line.
The pulmonary artery is extending beyond the tangent line (apex of the left ventricle to aortic knob) which indicates increased flow or pressure in the pulmonary circulation.Might suggest enlargement from pulmonary hypertension, stenoticchanges of pulmonary valve. Commonly found normally in females, but it is still a bad sign.
Main pulmonary artery projects beyond the tangent line. If the main pulmonary artery (closed white arrow) projects beyond the tangent line (greater than 0 mm) (black line), this is almost always abnormal. This can occur if there is increased pressure or increased flow in the pulmonary circulation. In this patient, there was increased flow from a left-to-right shunt secondary to an atrial septal defect. Younger females may have main pulmonary artery segments that are normally prominent, but the main pulmonary artery, even though prominent, still does not usually project beyond the tangent line.
What is this? what is this seen in? what causes it?
An enlarged left atrium can cause the area where there is supposed to be an indent to appear bulged out or straightened meaning the space should be filled with the left atrium. This indicates enlargement of the left atrium, also remember you should see a double density sign on the right side of the chest, so check both sides of spine for signs of left atrial enlargement.
Causes: This is usually seen in mitral valvulardisease, in particular mitral stenosis. This patient had rheumatic heart disease leading to mitral stenosis.
What are some things you find in let atrial enlargement?
What is this? what are the multiple things found in this image? what causes it?
mitral stenosis leading to left atrial enlargement
There is a convexity rather than a concavity on the left heart border due to an enlarged left atrium and enlarged left atrial appendage (open black arrow) and there is a double density on the right heart border caused by the enlarged left atrium (closed black arrow) superimposed on the normal right atrium (closed white arrow). This patient had mitral stenosis. Note that the heart is not enlarged and the underlying abnormality is diagnosable only by recognizing the abnormal contours of the heart.indicative of left atrium enlargement which goes along with mitral stenosis.Left atrial pressure increased, after stenosis can develop dilation and left ventricular enlargement..
Left ventricular enlargement best placeto tlookis aorta and see if it is dilated beyond the normal level tangent line from aortic line to apex and the pulmonary artery may be considered falsely normal when it is a left ventricular problem.
what is this? how do you do it? in what view is it best to measure it?
Cardiothoracic Ratio
?- is it really enlarged AP Film. casting bigger shadow closer to the light
?- is it really normal, PA smaller the further away from the light
Ratio is usually less than 50%. Measure from right edge to left edge, compare to total thoracic measurement
Conditions that could make a heart appear enlarged when it isn’t are- pregnancy, ascites, obesity, and anatomical conditions such as pectus excavatum
The ratio can be less than 50% and be abnormal; pt can have an outflow problem- meaning outflow from the ventricles is obstructed which produces hypertrophy which does not show recognizable cardiac enlargement; if you suspect this is the case you must look at the cardiac contours
what does this picture indicate?
Determining which ventricle is enlarged. The easiest way to evaluate which ventricle is enlarged (right or left) is to look at the corresponding outflow tract for each ventricle. If the heart is enlarged (i.e., the cardiothoracic ratio is greater than 50%) (black double arrow) and the main pulmonary artery is large (white arrow), i.e., projects beyond the tangent line (white line), then the cardiomegaly is made up of at least right ventricular enlargement because the pulmonary artery is the corresponding outflow tract for the right ventricle. Setting someone up for heart failure,but usually has been a long time for this to come about before heart failure began.
Measuring cardiac enlargement- use black line as cardiothoracic ratio- should use whole lung field. Can determine form this cxr-to see whichventricle is causing it and the outflow tracks. If pulmonary artery enlarged (right ventricle causing). Aorta enlarged or tortuous (left ventricular dysfunction)
What does this picture show?
Determining which ventricle is enlarged. If the heart is enlarged, i.e., the cardiothoracic ratio is greater than 50% (double black arrow), and the aorta is prominent (ascending aorta, aortic knob, and descending aorta) (closed white arrows), then the cardiomegaly is made up of at least left ventricular enlargement. Once one ventricle is determined to be enlarged, it is usually not possible to determine if the other ventricle is also enlarged on a conventional chest radiograph.
Againcardiomegaly with enlarged ascending aorta, white arrows on left side indicate descending aorta. Cannot tell if the right ventricle is enlargedas well, but you cannot properly measure the pulmonary artery and get a false normal reading because of the enlarged aortic knob. LVH go w/ an echo to actually assess chamber size and functionality.
How do you measure this? what size is it supposed to be? what can it indicate?
Measuring the right descending pulmonary artery. The right descending pulmonary artery is visible on almost all frontal chest radiographs as a large vessel just lateral to the right heart border (open white arrow). It serves the right lower and right middle lobes. You can measure its diameter before it branches (white line) to make a more objective assessment of the pulmonary vasculature. In normal subjects, the right descending pulmonary artery measures less than 17 mm in diameter. This is a handy way to separate normal from most abnormal types of pulmonary vasculature.
We need to look at 3 different areas to evaluate the pulmonary vasculature- right descending pulm. Artery (bottom most of split artery going to lower and middle lung), distribution of flow in lung from apex to base and from central to peripheral
Right descending pulmartery- just to the right of the right heart border, should measure less than 17 mm in diameter.
Something blocking forcing them to be dilated and Indicating pulmonary hypertension. Vasospasm etc.
Enalrgedcardiac silhouette and aorta not bigger than it should be, with large right descending pulmonary artery w/ ventricle enlarged one.
what is the significance of looking at these vessels what can go wrong with them and what can they indicate?
Three parameters used to assess the pulmonary vasculature. Normally, in the upright position the right descending pulmonary artery should be less than 17 mm in diameter (white line). The distribution of flow from apex to base can be assessed by examining the size (not the number) of vessels in two imaginary circles at the right base and either apex (white circles). The vessels should be larger at the base in the upright position. The last assessment of the distribution of flow is made by examining the gradual and progressive tapering of vessels as they travel from the hilum to the periphery of the lung (closed white arrows).
Measure the RDPA
Look at the vessels at the apex and the base- the vessels at the base should be larger than the ones at the apex in an upright CXR because the blood flow is greater in the bases- the circles you see here. Should not be done on left side due to heart and not be done on a supine cxrbecause gravity dependent.
If not: Dilation in apical blood vessels or constriction in the bases, can be due to stenoticlesion or pulmonary embolus decreasing bloowflow. Or increased intravascular pressure causing vasodilation not the number but the size of them. Should be smooth tapering as they go from main pulmonary artery to the end (no major shrinking- can be obstruction such as plague or embolus)
Central to peripheral- the vessels should taper gradually from medial to lateral or central to peripheral. They are larger in diameter closer the main pulmvessels and smaller in diameter the farther out they go
what is this? what does this mean?
water bottle shaped heart
Pericardial effusion. The cardiac silhouette is markedly enlarged. This heart was more than 65% of the cardiothoracic ratio. This is a dilated or a delta-shaped heart. The main differential diagnosis for such a heart is pericardial effusion versus cardiomyopathy, and they are frequently difficult or impossible to differentiate on conventional radiographs. In this case, though, the globular shape of the heart and the absence of any recognizable cardiac contours leads toward pericardial effusion. The patient had uremic pericarditis. Notice that the soft tissue density of the heart and the pericardial fluid appear as the same radiographic density with conventional radiography. Pericardial effusion is best diagnosed using ultrasound.
Pericardial Effusion Called delta or dilated shaped heart, is almost the same amount dilated on both sides of spine. Fills up left ventricle first when laying down then right then evenly, develop uniform shape.
describe the progression of what you are looking for when looking at cxr in the heart?
What are the findings found in cxr for CHF? what is it caused by?
- Causes
- Coronary artery disease
- Hypertension
- Cardiomyopathy, cardiac valvularlesions, arrhythmias, hyperthyroidism, severe anemia, left-to-right shunts
Patterns on CXR
- Pulmonary interstitial edema
- Pulmonary alveolar edema
What is pulmonary intersitial edema? what are its findings?
- Fluid collecting outside of the lung on low spots of the lung and vascular spaces.
- Thickeningof interlobular septa.Septa between lobes and lobular septa.
- Peribronchialcuffing-edema around the blood vessels themselves
- Fluid in fissures
- Pleural effusions
What are are these? what make them up? what are they indicative of?
KerlyB lines- Fluid in the interlobular septa of the lung. short, very thin and horizontal. Very hard to distinguish, look for with other signs of CHF. Occur when interlobular septa accumulate too much fluid, usually at the bases or angles, may become chronic. Comment on radiologists report
Not usually seen I CXR near costophrenic angles.
Short, thin, horizontal, perpendicular to pleura. Can fibrose and remain
What are are these? what make them up? what are they indicative of?
KerlyA lines- edema and fluid collecting in connective tissue in the lungs (not a channel, but swelling in the connective tissue structuresin the hilum). appear when connective tissue around the bronchoarterialsheaths in lung distend with fluid. Extend from hila up to 6 cm but not to periphery, so should not confuse with B lines
What is this? what causes this? what is this an indicator of?
what is the progression?
Peribronchialcuffing- when fluid accumulates in interstitial tissue around and in wall of bronchus, the bronchial wall becomes thicker and appears as ring.Like doughnuts-Whiter area around airway with fluid in the wall,indicatingedema around vessel wall). Difficult to see.
peribornhcial cuffing and kerley A
Treatment: diurhesis, get fluid away and the white area will shrink
Bronchi normally visible in hila but thin walls make them not visible in periphery
What is this? what causes this? what is this an indicator of?
what is the progression?
Fissure becomes more visible, thicker, irregular in contour, can happen in any fissure, fluid collects in sub pleural space or between the two visceral layers of lung, A normal; B more thick and visible. Right lung lateral view can see heart as well.
CHF
Visible normally never thicker than a line drawn w/ a sharpened pencil
Fluid collecting between two layers of visceral pleura forming fissures making thicker and more irregular
What is this? what causes this? what is this an indicator of?
what is the progression?
Bilateral PE, as seen on the bottom of the picture or posterior because the pt is lying supine
Does anyone know what the closed white arrows are pointing at? Other fluid accumulationin blood vessels and bronchi. Collect most on the right side (traumatic, CHF a lot less concerning) of the chest with the right side having more space because no heart for it to collect.
If on the left- have to worry about neoplastic condition, tuberculosis
Normal amount of fluid in pleural space is 2-5mL, fluid can start collecting in the space at 20mm Hg wedge pressure; usually bilateral in CHF, if unilateral- usually on the right side
If you do see on the left- most likely not HF, so you should consider other disease processes like TB, mets
Increased production or decreased absorption of pleural fluid
Making bilateral effusion
When unilateral-mostly right sided
what is the difference between the two?
Do you notice the difference in two views?
Look at A- what do you see?
Look at B- what do you see?
Same pt A is supine, B is upright
What is pulmonary aveolar edema?
fluid in the airway itself
Increased pulmonary venous pressure fluid backing up and capillaries are starting to leak fluid and as they leak out go inside alveoli
Also called pulmonary edema, occurs when pulmon. Venous pressure is elevated 25 mmHg. This causes fluid to spill out of interstitial spaces into the airspaces.
Fluffy, patchy densities
Butterflyor batwing
Fluffy, indistinct, patchy airspace densitiescentrally located sparing the outer third
Lower lung zones more affected than upper
Pleural effusions and fluid in the fissures found here as well
What is this? how would you treat them?
spotty mottled appearance collcting in alveoli spreading out not consistent color
vasodilate them in ER then diurhesis them (first in home care)
Bat wing or Butterfly appearance, increased whitening, fluffy, centrally located and spares outer third of lung
What is this? what causes this? what is this an indicator of?
Cephalization-redistribution of flow in lungs so that the upper lobe pulmonary vasculature larger than lower lobe. Patient must be upright
Cephalization- pressure from the fluid going to show. Diameter of blood vessels should be wider at the bases but finer higher upevidence of fluid pressure in vasculaturforcing vessels to open up again and if something is not opening up it has to give.
Cardiomegaly is not always present in CHF, although a majority of pts do have it and also have CHF. Do not assume because the pt does not have cardiomegaly but does have other signs of CHF that it is not CHF. Cephalization is shown here in this CXR, notice the increase density of the pulmonary vasculature on both sides. Cephalization is very hard to appreciate and is not always an accurate finding due to pt position.
Most patients w/ CHF have enlarged heart
Cardiomegaly- Most patients w/ enlarged heart are not in CHF. Not sensitive for CHF
Resolution begins peripherally moving centrally
what is it?
massive thoracic aortic aneurysm. widened aortic knob want CT to assess how much is true aneurysm or if there is any active leaking of blood between intima and outer portion of the vessel
could surgically fix on young patient
if older, let go
Pain radiating to the back >4cm between 5-6cm rupture
Aneurysms enlargements >50. asymptomatic
Ascending aneurysms- extend anteriorly and to the right most likely to dissect accompanied by widening of the mediastinum, loss of shadow of aortic knob, deviation of trachea or esophagus to the right
Aortic arch- middle mediastinal mass
Descending aorta- posteriorly, laterally, and to the left
Use CT
Fusiform-long, or sacular
what is it?
Due to traumatic aortic injury like aneurysm rupture flooding blood into mediastinum catching and confinding it stretching it.
Due to dissecting aneurysm
Aortic aneurysm, conventional chest radiograph, and CT. A,Close-up view of a frontal radiograph of the chest demonstrates a large mediastinal soft tissue mass (white arrow). This soft tissue density represents a large aneurysm of the proximal descending aorta seen also in the CT scan
what are these what do they indicate?
Artifactualfindings include A lines (not the same as KerleyA!), which are horizontal echoes from the pleura that reverberate deeper into the lung; and comet tail artifacts, which are vertical hyperechoicareas extending perpendicularly from the pleura
B-Linesarethe equivalent of Kerley-B’s thickened interlobular septamore dense because of the excess fluid collecting in there. Fluid attenuating that signal. Normal Pleural is straight or smooth. If more than 2-3 suggestive of heart failure.
Ultrasound for pleural effusion
▪A 63-year-old male presents to his cardiologist for an annual check-up.
▪He has a 35-pack-year history of smoking and a past medical history characteristic of hypertension and hyperlipidemia.
▪The patient remarks that he has been trying to control his cholesterol for years with diet and exercise modifications.
▪Vital Signs: BP 138/90 mmHg, Pulse 62 beats per minute, BMI 27.8 kg/m2.
▪Physical exam grossly unremarkable, except for a heart murmur.
soft, early to midsystolicejection murmur in the 2nd right interspace with a normally split S2 without a click (Usually prolapse or stenosis).
Most common murmur! aortic fibrosis innocent murmur
▪Asymptomatic condition that is usually only apparent with auscultation. no obstruction to flow and an ejection murmur
▪Its sole sign is an ejection flow murmur with a normally split S2 (▪begin at the end of the first heart sound (S1), are crescendo-decrescendo in loudness, end before the second heart sound (S2).
▪Does not radiate into carotid separating it from stenosis, carotid pulses normal
▪Also called the innocent murmur of the elderly
▪Prevalence is as high as 50% at age 50.
▪Risk factors associated with AVS are similar to those of atherosclerosis and typically include:
▪increasing age, male gender, smoking, HTN, and elevated LDL cholesterol
▪A 59 year old man presents with a history of a heart murmur since childhood and was diagnosed with aortic valve disease in the late 1980s. The patient runs every other day but has noticed a recent reduction in stamina, occasional chest pain, and intermittent dizziness. He has no significant past medical history or family history of heart disease.
▪BP: 131/76 mmHg, Pulse: 65 bpm, regular.
▪Cardiac Exam: No abnormal impulses.
Carotids: Somewhat difficult to palpate, moderately diminished; delayed upstrokes noted.
- Grade 3 systolic crescendo-decrescendo murmur and grade 1 diastolic decrescendo murmur are present.
- S1 is normal but the aortic component of the S2 is diminished. Harsh and S2 is weaker
- Decrescendo after S2
aortic stenosis
what is this?
Substernal thyroid mass.The lower pole of the thyroid may enlarge but project downward into the upper thorax (white oval)rather than anteriorly into the neck. Classically subster- nal thyroid goiters produce mediastinal masses that do not extend below the top of the aortic arch (white arrow). Substernal goiters characteristically displace the trachea (black arrow)either to the left or right above the aortic knob, a tendency the other anterior mediastinal masses do not typically demonstrate. Therefore you should think of an enlarged substernal thyroid goiter whenever you see an anterior mediastinal mass that displaces the trachea
Mediastinal adenopathy from Hodgkin disease.Lymphadenopathy frequently presents with a lobulated or polycyclic border as a result of the conglomeration of enlarged nodes that produce the mass (solid white arrows). This finding may help differentiate lymphadenopathy from other mediastinal masses. Mediastinal lymphadenopathy in Hodgkin disease is usually bilateral (dotted white arrows)and frequently asymmetric.
Thymomas are neoplasms of thymic epithelium and lymphocytes that occur most often in middle-aged adults, gener- ally at an older age than those with teratomas. A,The chest radiograph shows a smoothly marginated anterior mediastinal mass (black arrow)
Chronic mitral stenosis with tricuspid regurgitation.The left atrium is enlarged (white arrow). Pulmonary venous hypertension has produced a redistribution of flow in the lungs so that the upper lobe vessels have become more prominent than the lower lobe (cephaliza- tion)(white circle). As a result of increased pulmonary vascular resistance and subsequent pulmonary arterial hypertension, the right heart also undergoes changes eventually, including tricuspid regur- gitation with enlargement of the right atrium (black arrow).
what is the subxiphoid view?
“The subcostal view is obtained by placing the probe just below the xiphoid process with the probe marker pointing towards the patient’s left hip. The subxiphoidview uses the left lobe of the liver as an acoustic window and involves angling the face of the probe up from the abdomen and into the left chest. ”
GIVES GOOD LOOK AT RV AND ASSESS FOR PERICARDIAL EFFUSION
STANDARD VIEW FOR CARDIAC VIEW IN THE FAST EXAM
What is this view? what can you see in it?
“The parasternal long axis (PSLA) view is obtained by placing the probe to the left of the sternum with the probe marker pointing towards the patient’s right shoulder. The probe is then gently dragged over the chest wall from the 2nd to 5th intercostal spaces, searching for the best acoustic window ”
pericardial and pleural effusion
What is this view? what can you see in it?
“Once the parasternal long axis view is acquired, the probe can then be rotated clockwise 90° with the probe marker pointing towards the patient’s left shoulder to obtain the parasternal short axis (PSSA) view (Movie 2.4). The PSSA view is an ideal view for assessing global LV function.
What is this view? what can you see in it?
“The apical 4-chamber (A4C) view is obtained by placing the probe inferior and lateral to the left nipple in men or under the left breast in women. The probe marker is pointed towards the patient’s left axilla and the face of the transducer is angled up towards the base of the heart ”
can see collapsing RV
What are the categories of BP in adults?
What are the common causes of secondary hypertension?
what are the symptosm for cushing?
excess glucocorticoids
hyperglycemia in labs
confirm w/ elevated cortisol
