Focused bedside Echocardiography
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How to perform rapid focused bedside Echocardiography Youtube lecture link: https://youtu.be/_AHiQDfMo7k
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The document provides an overview of echocardiography techniques for assessing various adult heart diseases. It discusses how to evaluate left and right ventricular function, aortic and mitral valve diseases, pericardial diseases, and cardiomyopathies. Evaluation of ventricular size and function involves 2D and Doppler echocardiography to measure dimensions, estimate ejection fraction, and calculate indices like fractional shortening. Valvular lesions are assessed using 2D to visualize anatomy and Doppler to measure velocities and gradients. Right heart function and pressures are evaluated using measurements of the IVC, RV size, TAPSE, and TR jet velocity.
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1) Transthoracic and transesophageal echocardiography are important modalities for assessing atrial septal defects (ASDs). TTE can identify RV volume overload and septal flattening, while TEE precisely measures defect size and evaluates rim morphology.
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2) Echocardiography can help determine the cause of hypotension such as tamponade, pump failure, hypovolemia, or pulmonary embolism. It also aids in optimizing treatment for conditions like pulseless electrical activity.
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2) The four main types of ASDs - ostium secundum, ostium primum, sinus venosus, and coronary sinus defects - have distinguishing echo features. Doppler can demonstrate shunt direction and magnitude.
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2) In d-TGA, the systemic and pulmonary circulations are arranged in parallel rather than in series, requiring blood flow between the circuits through connections like an atrial or ventricular septal defect.
3) Echocardiography is useful for diagnosing d-TGA by demonstrating the aorta originating from the right ventricle and pulmonary artery from the left ventricle, as well as identifying the origins of the coronary arteries.
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This document discusses the case of a 2 year old male child presenting with recurrent lower respiratory tract infections. On examination, a systolic murmur was heard. Echocardiogram showed a patent ductus arteriosus (PDA) of size 8mm with left to right shunting. Cardiac catheterization found a Qp/Qs ratio of 1.83, confirming a left to right shunt. Post oxygen, the Qp/Qs ratio increased to 2.94, and PVR decreased, indicating reactivity. The document then discusses two other cases and provides information on indications for catheterization in PDA, angiographic views, classifications of PDA, and factors affecting shunting through a PDA
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This document discusses tools and techniques for left ventricular lead implantation in patients with complex cardiac anatomy:
1. It recommends having backup pacing available and describes approaches for implanting the right ventricular lead first or left ventricular lead first.
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3. Techniques are provided for overcoming challenges with each step like variable coronary sinus anatomy, dilated right atrium, valves obstructing advancement, and small vessel size. The importance of pre-procedural venography is emphasized for selecting optimal target
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This document provides an overview of M-mode echocardiography. It discusses the history, physics, clinical use and limitations of M-mode. Key points include:
- M-mode allows for high temporal resolution to evaluate the timing of cardiac events and high axial resolution of delicate structures. However, it only assesses motion in one dimension.
- Normal M-mode findings of structures like the left ventricle, mitral valve and aortic valve are described.
- Pathologic conditions that can be identified include hypertrophic cardiomyopathy, dilated cardiomyopathy, mitral valve prolapse/flail, and valvular stenosis/regurgitation.
- Additional applications of M
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1) Coronary artery anomalies (CAAs) are defined as morphological features found in less than 1% of the population. They can be classified based on origin, course, termination, or hemodynamic significance.
2) Some important CAAs include anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), anomalous origin of the coronary artery from the opposite sinus (ACAOS), and coronary artery fistulas.
3) ALCAPA causes retrograde flow of blood from the right coronary artery to the pulmonary artery. ACAOS, especially when the ectopic artery takes an interarterial course, can cause ischemia. Coronary artery fistulas can lead to complications like aneurysm formation
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This document discusses how to evaluate tricuspid regurgitation (TR) using echocardiography. It provides two case examples:
1. A case of secondary TR due to annular dilatation from right atrial and ventricular dilatation. Severe TR is shown by a large regurgitant jet on color flow mapping with a measurable vena contracta and proximal flow convergence.
2. A case of primary organic TR involving prolapse or a flail leaflet. Severe TR is evident before color flow mapping due to right heart dilation and dysfunction. Color flow mapping shows a torrential regurgitant jet with a wide vena contracta and proximal flow convergence.
The document reviews
TEE VIEWS
This document provides an overview of standard transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) views. It describes the imaging windows, planes, and positions for obtaining basic and modified TTE views such as parasternal, apical, and subcostal views. It also outlines TEE imaging levels and how to manipulate the probe to obtain standard midesophageal and transgastric views, including 4-chamber, 2-chamber, aortic valve, and left ventricular views. The document aims to guide practitioners in performing comprehensive TTE and TEE exams through appropriate patient positioning and transducer manipulation.
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preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
Ventricular septal defect
1. A ventricular septal defect (VSD) is an opening in the wall separating the ventricles that allows blood to shunt between them.
2. VSDs are the most common congenital heart defect in children and can be classified based on their location as membranous, perimembranous, muscular, inlet, or outlet.
3. A complete echocardiogram is needed to evaluate the location, size, direction of shunting, and effects of the defect. Three-dimensional echocardiography can help further define the anatomy and guide potential transcatheter closure of the VSD.
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This document provides an overview of echocardiographic assessment of mitral regurgitation. It describes the anatomy of the mitral valve including the leaflets, annulus, chordae, and papillary muscles. It discusses Carpentier's functional classification system for describing the mechanism of mitral valve dysfunction. Methods for assessing severity are covered, including color flow imaging, continuous wave Doppler, vena contracta width, proximal isovelocity surface area, and volumetric assessment. Key points are made about evaluating jet direction, duration, and velocity in context of blood pressure. The importance of assessing left ventricular and left atrial size and function is also highlighted.
Asd echo assessment
This document discusses the echocardiographic assessment of atrial septal defects (ASDs). It describes the main types of ASDs and notes that 80% are secundum defects. Echocardiography is used to identify and characterize ASDs, detect associated anomalies, diagnose complications, and guide treatment. Transthoracic echocardiography is the initial study, while transesophageal echocardiography provides better views of the atrial septum. Key measurements include ASD size, location, rim dimensions, and quantifying shunt severity with Qp/Qs. Echocardiography guides decisions about ASD device closure or surgery.
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This document provides an overview of cardiac emergencies for nurses. It begins with definitions of medical and cardiovascular emergencies. It then covers assessment of the cardiovascular system, ECG interpretation, common rhythm disturbances like tachycardias and bradycardias, and treatment protocols for cardiac arrest, chest pain, acute coronary syndrome, and other conditions. Nursing interventions are described for monitoring, medication administration, and supporting patients experiencing cardiovascular emergencies.
Rodent Models of Heart Failure and Cardiac Ischemic Injury
1) The document describes several animal models used to study heart failure, including models that induce heart failure through myocardial infarction or pressure overload.
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3) Ischemia-reperfusion injury models, where the coronary artery is temporarily occluded then reperfused, are also used and can assess treatments administered prior to or after the ischemic event.
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Coronary CT angiography allows for noninvasive imaging of the heart and coronary arteries. It can be used to evaluate patients with chest pain, assess coronary arteries after revascularization, and detect congenital coronary anomalies. The scan involves a non-contrast scan for calcium scoring followed by a contrast-enhanced scan. Proper patient preparation including beta-blockers and nitroglycerin is important. Images are analyzed using techniques like multiplanar reformation, maximum intensity projection, volume rendering and curved reformation to evaluate coronary artery anatomy and detect any stenosis.
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The electrocardiogram (ECG or EKG) measures and records the electrical activity of the heart. It was developed in 1893 by Willem Einthoven, who received the Nobel Prize for his work. An ECG works by detecting the tiny electrical changes on the skin that occur with each heartbeat. It shows the heart's rate and rhythm, as well as any damage to heart muscle. A standard 12-lead ECG provides multiple views of the heart and can help diagnose conditions like heart attacks.
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This document provides guidance on preparing for the European Exam in Core Cardiology (EECC). It outlines the exam format, resources for preparation, and topics covered. The key points are:
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This document discusses angina pectoris, or chest pain caused by reduced blood flow to the heart. It begins with an introduction and overview of angina. The main causes of angina are coronary artery disease and atherosclerosis which can lead to plaque buildup and blockages in the arteries supplying the heart. The document then covers clinical evaluation of patients with chest pain through medical history, physical exam, electrocardiograms and imaging tests. It outlines treatment goals of slowing disease progression, preventing heart attacks and relieving symptoms through risk factor control, medications like statins, blood pressure medications, aspirin and nitrates as well as procedures like coronary stenting. The role of lifestyle changes like diet, exercise and smoking cessation are
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This document provides guidance on performing a cardiac examination, including examination of:
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Pericardiocentesis
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SGLT2 inhibitors
SGLT-2 inhibitors have shown promising cardiovascular and renal benefits:
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2) Studies also show SGLT-2 inhibitors improve outcomes for patients with heart failure with reduced ejection fraction, reducing rates of heart failure hospitalization and mortality regardless of diabetes status or background heart failure therapies.
3) SGLT-2 inhibitors were also found to reduce the risk of renal death or progression to end-stage kidney disease in patients with type 2 diabetes and macroalbuminuria.
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Focused bedside Echocardiography
- 1. How to perform a focused bedside Echocardiography ? Ahmed Elborae How to ? series
- 3. Every ER shift scenarios • 40 years old gentleman, smoker , presenting to ER with 3 hours history of severe chest pain, 1st set Troponin-I is negative • Cardiac Ischemic ? (CAD) • Cardiac Non-Ischemic (Dissection, embolism, pericarditis, etc.…..) • Non cardiac
- 4. Every ER shift scenarios • 60 year old lady, vague history of ischemic heart disease, diabetic foot, presenting to ER with shock Septic shock ! Definitely cardiogenic shock ! Cardiologist Internal medicine
- 5. Every ER shift scenarios • 35 years old lady, presenting with shortness of breath and chest pain , examination is free Pscychic?
- 6. • Patient returned to ER 2 hours later shocked !!!!
- 8. Fortunately, you don’t need this !
- 10. CW: Continuous wave Doppler= Gradient M-mode= Cut section Color Doppler= Flow Gain= contrast Acquire= save Measure=General measures Calc.=Specific measures Enter= Ok Depth= Depth : ) Be familiar with the machine ! PW: Pulsed wave Doppler= Pressure at point
- 11. Clinical implications 1-Chest pain +/- SOB D.D
- 12. Chest pain +/- SOB MI PE Dissection Pericarditis Clinical ECG,ABG,CXR Well’s criteria > CTPA/D-dimer Clinical ECG Troponin Clinical CXR CT aortography Clinical ECG Troponin Echocardiography RWMA RV&PASP Flap-AR Effusion
- 15. Chest pain +/- SOB 2-Pulmonary embolism McConnell's sign 60/60 sign RV dilatation
- 17. Chest pain +/- SOB 3-Aortic dissection Just space above, Color for AR
- 20. Chest pain +/- SOB MI PE Dissection Pericarditis Clinical ECG,ABG,CXR Well’s criteria > CTPA/D-dimer Clinical ECG Troponin Clinical CXR CT aortography Clinical ECG Troponin Echocardiography RWMA RV&PASP Flap-AR Effusion
- 22. Shock Cardiogenic Septic/Hypovolemic Obstructive Pulmonary embolism Obstructive Tamponade Clinical Sepsis markers SOFA score Clinical ECG Clinical CXR CTPA Clinical ECG Echocardiography EF%,IVC, Valves EF%,IVC RV-ePASP-PA Effusion
- 23. Cardiogenic shock 1-Assessment of LV function PLAX view Probe position Knob towards Right shoulder PLAX view M-mode EF%
- 24. Or just eye balling
- 25. Or just eye balling
- 26. Cardiogenic shock 2-Assessment of Volume status Probe position Knob points 12 O clock Subcostal view Dilated IVC, collapse < 50%
- 27. Cardiogenic shock 3-Assessment of lung congestion Congested lung Vertical (B-lines) Normal lung “Horizontal A lines” Probe position Knob points upward ( 12 O clock) ≥ 3 B-lines in + ≥ 2 sites Lung comets
- 29. Stroke volume and cardiac output calculation PLAX view A5 view
- 30. Obstructive shock Pulmonary embolism McConnell's sign 60/60 sign RV dilatation
- 32. Rate dependent not volume dependent Obstructive Shock Cardiac tamponade
- 33. Obstructive Shock Cardiac tamponade Measure at end diastole not systole
- 34. Late diastole Inspiration Early diastole Inspiration A4 view A4 view
- 35. RV diastolic collapse by m-mode PLAX
- 36. Respiratory variation > 25% PWD mitral or > 40% PWD tricuspid
- 37. Shock Cardiogenic Septic/Hypovolemic Obstructive Pulmonary embolism Obstructive Tamponade Clinical Sepsis markers SOFA score Clinical ECG Clinical CXR CTPA Clinical ECG Echocardiography EF%,IVC, Valves EF%,IVC RV-ePASP-PA Effusion
- 38. 1 1&2 2 3 4 4 3 1-LV function (Global- RWMA) 2-RV (Dilatation-PASP) 3-Pericardium 4-Aorta 5-IVC
- 39. Further reading
- 40. Further practice
- 41. Thank You