POCUS - Cardiac Flashcards
What are the ranges for TAPSE?
Less than 1.6 cm is positive
1.6 to 2.0 cm is indeterminate
Greater than 2.0 cm is negative
McConnell’s sign is what?
Hypokinesis of the lateral wall of the RV and hyperkinesis of the RV apex.
Normal IVC diameter is what?
1.5 to 2.0 cm
With respiratory variation!
Describe the orientation of the probe and the heart in the subxiphoid view.
The probe marker on the curvilinear probe pointes to the patient’s right.
The heart will show the RV in the 12 o’clock position, the LV in the 3 o’clock position, the LA in the 6 o’clock position, and the RA in the 9 o’clock position.
The best position for the cardiac exam is _____________.
LLD
In the subxiphoid view with the cardiac probe, the indicator bump should be on the patient’s ___________.
left
Actually, in all views except the parasternal long, the probe points to the patient’s left.
In the IVC view with the cardiac probe, the indicator bump should be on the patient’s __________ side.
caudal side
This makes it so that on the screen the cephalad side is on the left.
With an abdominal probe (such as during a FAST exam) the probe dot should point up to recreate the same orientation on the screen.
Explain the “bagel and croissant” view.
In the parasternal short axis, the LV looks circular (like a donut) and the RV looks crescent-shaped (like a croissant).
The ___________ is just posterior to the aortic outflow tract.
LA
To find the optimal intercostal space for the parasternal view, ______________.
palpate the border of the sternum and then slide the probe from high to low just lateral to the border
To get the best angle for the apical four-chamber view, try to match the probe up to this axis: ________________.
the axis that goes from the right shoulder to below the left nipple
In the apical four-chamber view, the probe marker should point to the patient’s _______.
left (so in cardiac mode, where the dot on the screen is on the right, the LV will appear on the screen’s right)
Actually, in all views except the parasternal long, the probe points to the patient’s left.
EPSS stands for _________________.
E-point septal separation
In evaluating for EPSS, the first wave is ___________.
the E wave, which occurs during ventricular diastole
Give the measurement criteria for EPSS.
< 8 mm: EF 55%
8 - 18 mm: EF 30-50%
> 18 mm: EF < 30%
What is the 1:1:1 rule?
In the parasternal long access view of the heart, the RV, LVOT, and LA should all be equivalently sized.
Review the ways you can evaluate for RV strain.
- Using the parasternal long access, look for the 1:1:1 rule to assess for RV enlargement.
- Using the parasternal short access, look for the D sign (the bowing of the ventricular septum toward the LV).
- Using either the subxiphoid or apical four-chamber views, look for RV>LV size.
- Using the apical four-chamber view, check for dipping of the RV apex (McConnell’s sign).
- Using the apical four-chamber view, check for TAPSE (tricuspid annular plane systolic excursion). To do this, place the M-mode marker over the lateral edge of the tricuspid valve. < 17 mm is abnormal.
** Be sure to differentiate chronic from acute RV strain. Someone with COPD might have a dilated RV without acute strain. To evaluate this, measure the RV wall at the end of diastole. If > 5 mm, then chronic RVH is likely.
In the transverse abdominal view, an IVC:aorta ratio < _____ has been shown to predict dehydration in pediatric patients.
0.8
What is the rating system for pericardial effusions in adults?
Find the deepest part of the pocket during diastole and measure.
- < 1 cm: mild
- 1-2 cm: moderate
- > 2 cm: severe
If you see signs of RV failure in a patient with chronic lung disease and you’re trying to assess acute insult (like a superimposed PE), what can you look at to gauge chronicity?
RV wall thickness
If greater than 5 mm then they likely have chronic RV failure and acute insult is less likely.
In the subxiphoid view, the apex of the heart should be pointing to the __________ of the screen.
upper right corner
To achieve this, the cardiac mode probe points to the right and the abdominal mode probe points to the left.
In the subxiphoid view, you have to be careful about interpreting LV:RV ratio because _____________.
it’s easy to get an angled section of the heart that can exaggerate either side
For the parasternal long axis, the probe should be in axis with the line that points from the right should to the ____________.
left hip
For the parasternal short axis, the probe should be in axis with the line that points from the left shoulder to the ____________.
right hip
If you see a large effusion and you want to differentiate acute vs chronic, what can you look for?
Look at the IVC!
In tamponade (which you would expect from a large acute effusion), the IVC will be dilated. If it is normal or collapsed then you can be reassured that they don’t have tamponade physiology.
In the PLAX, how can you differentiate pleural effusion from pericardial effusion?
Pericardial effusion will go above the descending aorta, whereas pleural effusion will stop at the aorta.
Post CABG patients are more likely to have _____________ pericardial effusions.
loculated left-sided
The best place to get the apical four chamber view is the ______________.
inframamillary fold in the mid-clavicular line
Where do you measure the depth of a pericardial effusion?
At the deepest pocket
When you see a pericardial effusion, you must get the __________ view.
IVC
This can help differentiate if there is tamponade physiology or not. If the IVC is collapsible then tamponade is effectively ruled out.
RV free wall greater than ______ is indicative of chronic RV strain (at end diastole).
1.0 cm
What is the normal value of the ascending aorta in the PSLA?
It varies depending on the slice that you take, but it varies from 2.0 cm to 3.6 cm.
What diameter is the upper limit of normal for the LA?
4 cm
A caval index greater than _______ suggests fluid responsiveness.
50%
The caval index is calculated by the following equation:
CI = (expiratory IVC diameter - inspiratory IVC diameter) / (expiratory IVC diameter)
Thew IVC is normally ______ in diameter.
1.5 - 2.5 cm
Less than 1.5 cm indicates need of fluids.
Less than 1.0 cm in a trauma indicates transfusion.
Greater than 2.5 cm indicates volume overload.
You can use the ______ mode to measure the respiratory variation of the IVC.
M
In the traditional cardiac mode, the indicator dot is on the __________ of the screen.
right side
