ECHO

Question 1

Lung sliding

Answer 1

Normal finding: shimmering, “ants on a log” appearance in 1R and 1L (or sandy beach and waves/barcode in M mode)

Present = 99% negative predictive value for pneumothorax
Negative: pneumo, COPD, ARDS, pleurodesis

If no lung sliding is seen, look for the lung point (sandy beach with waves, waves come in and out of focus) –point where sliding comes in and out of view. 100 % specific for pneumo

Question 2

A lines

Answer 2

Appear as horizontal lines originating from the pleura, equidistant apart
Indicates dry interlobular space (90% specific for PAOP <13 –> dry lungs and low L sided pressures)

Question 3

B lines

Answer 3

Appear as comet tails originating from the pleura all the way to the bottom of the screen. Can also be described as spot lights

1-2 B lines can be considered physiologically normal

Indicates sub-pleural interstitial edema
B-lines will obliterate A-lines

Question 4

Parasternal short axis

Answer 4

4 views:
mitral valve–flickering
papillary muscles–circle w/ muscles appearing on sides
apex
aorta/RV–visualize RA, LA, RVOT, AV, PV, TV

Best view for measuring LV function. Only view where all 4 walls can be seen at once. Make all assessments from papillary view

Normal: all walls of heart should be pulling in the same amount during systole

Question 5

Parasternal long axis

Answer 5

Assess: LV size and function, pericardial or pleural effusion, Mitral or aortic valve regurgitation, and the Left ventricular outflow track (LVOT) diameter.

Good image includes: RV, LV, LVOT, aorta LA, descending aorta
*not a good view of RA

Normal: LV: Aorta: RV 1:1:1 in size, aggressively bouncing mitral walls, LV changes size by 1/3 during systole

Question 6

Apical 4 chamber

Answer 6

RV, RA, LV, LA

All 4 chambers visualized at once, great for determining overall cardiac functioning

Question 7

Apical 5 chamber

Answer 7

Tilt up from LV until aorta opens into view

RV, RA, LV, LA, Ao

LV should be 2/3 the size of the overall heart
RV should be 1/3 of the LV

L annulus should bounce approx 1 cm during systole
R (tricuspid) annulus should bounce approx 1.8 cm during systole

Question 8

Subcostal view

Answer 8

Liver at the top, RA, RV, LA, LV

Best view for pericardial effusion, tamponade, visualizing cardiac activity during a code

Question 9

IVC Longitudinal

Answer 9

IVC and aorta run next to each other

Aorta is pulsatile, but if aorta is overdistended, IVC can also look pulsatile

IVC surrounded by liver on both sides, hepatic vein runs into IVC, IVC runs into RA

Best view for assessment of fluid status using sniff test: IVC collapse w/ light sniff in spontaneously breathing pt