Pathology: Extra steps for echo Flashcards
Infective Endocarditis
req says
IE
fever
IVDU
SBE
vegetation
- Zoom on all valves in every view: look for veg on upstream side of the valve
Cardiac masses
- Image it and measure it
Thrombus
No extra steps
zoom in and image in multiple views
any clot is an emergency
Pulmonary Embolism
No extra steps
Look for clues of PE in right heart:
- RV dilation and dysfunction with normal/hyperdynamic LV
- McConnell sign
- 60/60 sign
Prosthetic valve
req says
AVR
MVR
- Determine the prosthetic valve area
- for TV and MV, need to do CW through inflow and trace (for continuity eqn)
- for AoV, do regular steps for continuity eqn or DVI
- for PV, just measure peak vel
Pericardial effusion
if small + pericardial effusion, must add steps for Tamponade:
1. Slow sweep speed PW through TV inflow (>60% variation)
2. Slow sweep speed PW through MV inflow (>30% variation)
Some sites:
3. HV (SC IVC view)
4. SVC (SSN, angle to right)
- for pulm vein PW, be sure to capture enough beats to see variation in flow
Constricted Pericarditis
- Slow sweep speed PW through TV and MV (exaggerated respiratory variations?)
- also look for annulus paradox…. CP is the only time you see this
PS
No extra steps,
except is can’t see well in 2D and get high vel from CW… do PW walkdown to find the site of stenosis
Measure the peak vel and PG
PI
No extra steps
brighter regurg trace and steeper slope means worse PI
TS
- do CW through TV inflow; trace to get mean PG (TS > 5 mmHg)
Some sites:
- measure PHT
TR
No extra steps (do CW through TR in every view)
visually assess TR: mild, mod, severe?
Some sites
- HV flow (SC - PW): s wave reversal?
MR
If Mod + MR,
1. do PISA measurement: lower baseline to 30 cm/s, freeze and measure PISA radius
2. do CW through MR and trace
machine calculates EROA = 2πr^2*Vn/Vmax
Some sites:
3. vena contracta (PLAX, freeze and measure jet at narrowest spot)
MS
on all patients with MS:
1. CW through MV inflow
- trace to get mean PG and MVA (via continuity eqn)
- meas EF slope to get PHT and machine will calculate MVA (MVA = 220/PHT)
*if significant MR, then continuity eqn not valid
AS
req says
SEM
No extra steps
AS: vel >2.5 m/s
AI
If mod + AI:
1. 5 ch CW through AI and measure PHT (steeper slope is smaller PHT and more severe AI)
2. Flow reversal in the desc/Abd Ao
- SSN: PW of desc Ao
- SC: PW of Abd Ao
site dep
3. AI jet width (as % of LVOT) and vena contracta
4. PISA - raise baseline to 30 cm/s
HCM/HOCM
req says
sudden death in family
brother died
SCD
ASH? Concentric hypertrophy? Apical hypertrophy?
if ASH with LVOT obstruction (CW and get high vel?):
1. do PW walkdown to prove location; switch to CW and trace with generic caliper
if LVOT PG is <30 mmHg at rest, do valsalva (CW and trace)
Note: will only be able to assess AoV visually.
DCM
No extra steps
RCM
No extra steps
ID amyloidosis?
ARVC
req says
frequent PVCs (and patient is young)
No extra steps
assess RV closely
LV non-compaction
No extra steps
To diagnose, need >3 trabeculations protruding from LV free wall in a single plane (image)
