Echo

Question 1

Echo set up:

Answer 1

Patient lying (tilted L if required)
Cardiac probe (‘phased array’)
Marker to patient RIGHT (opposite most)
Machine to patient RIGHT

https://www.pocus101.com/cardiac-ultrasound-echocardiography-made-easy-step-by-step-guide/#Cardiac_Ultrasound_Indications

Question 2

Answer 2

Think about where probe is ‘looking’
–> which structure it first encounters: this will be at top of field

Question 3

Echo probe position: PARASTERNAL LONG AXIS

Answer 3

Marker toR shoulder

Question 4

Echo probe position: PARASTERNAL SHORT AXIS

Answer 4

Marker to LEFT shoulder

Like an axial slice so need to scan around
–> start MID PAPILLARY
–> slide up to MITRAL VALVE level (‘Fish Mouth’)
–> angle up to AORTIC VALVE level (‘Mercedes Benz’)

Question 5

Echo probe position: APICAL 4 CHAMBER

Answer 5

Question 6

Echo probe position: SUBXIPHOID

Answer 6

Question 7

Echo probe position: IVC VIEW

Answer 7

Look to RUQ
Identify IVC within liver (big, deepest)
Centre IVC on screen
Rotate clockwise
–> Should see long axis IVC entering RA

Question 8

Echo views: PARASTERNAL LONG AXIS

Answer 8

“In the Long axis view, the Left ventricle is on the L eft of the screen”

Question 9

Echo views: PARASTERNAL SHORT AXIS

Answer 9

Mid-Papillary

Look for 2 pap muscles attached to sides

Question 10

Echo views: PARASTERNAL SHORT AXIS

Answer 10

**Fish-Mouth* (Mitral valve view)

Look for ring/ fish mouth of mitral valve

Question 11

Echo views: PARASTERNAL SHORT AXIS

Answer 11

(Mercedes Benz) Aortic valve level

Look for MB sign of AV

Question 12

Echo views: APICAL 4 CHAMBER

Answer 12

Transecting at apex (LV/ RV) –> THESE will be first

Question 13

Echo views: SUBXIPHOID
Be most familiar: eFAST

Answer 13

Very similar to apical 4 chamber, except

Transecting at underside (RV) –> THIS will be first

Question 14

Echo views: IVC VIEW

Answer 14

Ask to sniff/breathe in: should collapse >50%.

(OPPOSITE in ventilated patients- should collapse during EXPiration)

Question 15

Answer 15

PE with RV strain (ie. submassive/massive)

• Dilated RV (RV:LV >0.9 on PLAX)
• Hypokinetic RV with hyPERkinetic RV apex (McConnell’s)
• D sign
  –> LV looks ‘D’ shaped due to dilated RV bowing into it
• Loss of normal IVC collapse (50%)
• Tricuspid regurg
• Thrombus

Question 16

Answer 16

Tamponade

• Pericardial effusion
• Swinging heart
• Systolic RA collapse
• Diastolic RV collapse
• IVC plethora (<50% var, >2cm)

Can tell syst/diast based on valves closed/open

Question 17

Answer 17

Pericardial effusion

Question 18

Answer 18

MV prolapse

MV usually opens into LV

• ‘Ballooning’ or prolapsing back into LA
• Retrograde Doppler flow

Question 19

How to grossly assess systolic function (LVEF)

Answer 19

Will generally be eFAST type setting, so subxiphi view

In normal function:
- LV walls coming close together in systole
–> around 2/3rds
- Mitral valve almost hits LV wall

A fully collapsing LV is hyperdynamic