Ultrasound EL: Echo/Cardiac Flashcards
FOCUS and its orientation
Focused Cardiac UltraSound; Different than the orientation cardiologists typically use, provides an image on the parasternal long axis view that is horizontally flipped from cardiology view
Name windows of TTE
3 primary windows: (1) subcostal (2) parasternal (3) apical
Name views of FOCUS/cardiac echo
: (1) Parasternal long axis (PSLA) (2) Parasternal short axis (PSSA) (3) Subcostal or subxiphoid (SX) (4) Apical 4-Chamber (A4C)
Probe used for FOCUS and why
Phase Array; Comes from a point and can go between ribs
PSLA technique and structures visible
Indicator angled towards patient’s right shoulder; RV (anteriorly), LA mitral valve (anterior and posterior leaflets), LV, and LV outflow tract including aortic valve and root (see p. 51 of EM Ultrasound booklet for image)
Normal measurement of aortic root in adult and technique for measuring; Best view for doing so
Less than 4.0 cm; Measure outer to inner (PSLA)
PSSA technique and structures visible
Start in PSLA and rotate probe 90 degrees counterclockwise (pointing indicator at right hip); LV appears in cross section (see p. 52 of EM Ultrasound booklet for image)
Levels of PSSA
4 levels of PSSA: (1) Apex (2) Papillary muscles (3) Mitral valve (“fishmouth”) (4) Aortic valve (“Mercedes benz”)
Fishmouth on FOCUS
Mitral Valve (visible in PSSA)
Mercedes benz on FOCUS
Aortic valve (visible in PSSA)
Clinical uses for PSSA
Overall LV function; Evidence of septal flattening (“D-shaped septum”) in RV strain
D-shaped septum
Septal flattening seen in RV strain (may be visible in PSSA)
Pts w/ poor parasternal windows but good subcostal windows
COPD pts
Pts w/ good parasternal windows but poor subcostal windows
Obese pts
Subcostal or subxiphoid (SX) technique
Probe placed under costal margin with indicator to patient’s right for four chamber view; Orient probe so that ultrasound plane is angled towards left chest, pressed into abdomen and under xiphoid using liver as window to visualize the heart
Landmarks for SX view
Liver, and hepatic veins draining into the IVC, right atrium, to the right ventricle; RV is to patient’s right (left side of screen), and lies adjacent to liver; Pericardium is echogenic structure between liver and free edge of RV (see p. 54 of EM Ultrasound booklet for image)
Clinical uses for SX
Best images of inferior pericardium, where effusion most likely to be seen
SX sagittal or long axis and visible structure(s)
Rotating probe clockwise 90 degrees from SX (indicator towards head); Allows visualization of IVC draining from abdomen into heart (see p. 55 of EM Ultrasound booklet for image)
Apical 4-Chamber (A4C) technique
Place probe as laterally as possible, usually just below and lateral to level of nipple in males or under breast in females (indicator directed to patient’s right)
A4C visible structures
Apex of heart should be seen at top of image, with interventricular septum extending vertically down the middle of the screen. As you look at screen, LV will be on right, RV on left. Deep to the ventricles (bottom of the screen) will be LA/RA, separated from the venticles by mitral and tricuspid valves, respectively
Clinical use for A4C
While perhaps most difficult of 3 primary views to obtain correctly, contains most overall info; Most useful for comparing ratio of RV: LV (which is normally 0.6:1; abnormal is > 1:1)
Normal versus abnormal measurement of RV:LV; Best view for doing so
Normal 0.6:1; Abnormal > 1:1; A4C
5 E’s of EP FOCUS and best view to capture each
(1) Effusion (SX): presence and degree of any pericardial effusion (2) Ejection (PSSA): LV function/ejection fraction (3) Equality: RV: LV ratio (A4C) (4) Exit: Thoracic aortic root measured at sinuses of valsava (PSLA) (5) Entrance: IVC for fluid status (Subcostal long axis)
LVH on FOCUS
LV wall in diastole > 12 mm
