Cardiac ultrasound: Difference between revisions

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[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Rads]]
[[Category:Radiology]]
[[Category:Ultrasound]]
[[Category:Ultrasound]]

Revision as of 16:15, 22 March 2016

Background

  • Use phased array probe
  • Important to realize that the cardiac ultrasound preset on some machines reverses the indicator marking with the probe indicator on the right. With the general ED ultrasound the probe indicator is on the left of the screen.

Technique

Cardiac Ultrasound.png

Parasternal Long

  • Pointer to the L hip, probe at L 3rd/4th intercostal space adjacent to sternum
  • Use to visualize global function and r/o pericardial effusion/tamponade
    • Can evaluate mitral valve, aortic valve, aortic root, LV squeeze

Parasternal Short

  • Pointer to L shoulder, probe at L 3rd/4th intercostal space adjacent to sternum
  • Tip: obtain parasternal long view, then rotate probe 90 degrees
  • Use to evaluate LV squeeze, R ventricle
    • R heart strain = dilated R ventricle

Apical 4 chamber

  • Pointer to Right, usually below nipple
  • Use to visualize global function (Left and right ventricle, squeeze)

Subxyphoid

  • Pointer to Right, subxyphoid with probe pointed toward head
  • Use liver to as acoustic window to visualize heart

Cardiac Subxyphoid.png

Suprasternal

  • Pointer at 12 o'clock (cephalad) and place in sternal notch
  • Move probe inferior and to the left to visualize aortic arch
  • Rotate probe clockwise for further image optimization
    • Can evaluate for aortic dissections/aneurysms and aortic stenosis/regurg.

Measurements

Aorta

  • Normal aortic root is <3.8 cm (parasternal view w/ dot pointing to Lt arm)

Classic Ultrasound Findings For Critically Ill Patients

Disease Cardiac IVC Lung (Phased Array) Lung (Linear)
MI Focal WMA
Mod/Poor squeeze
NL or B-lines Sliding
Tamponade RA collapse with filling
RV collapse with filling
NL Sliding
PTX NL or Hyperdynamic Lung point
Consolidated lung
Absent lung sliding
Sepsis Hyperdynamic squeeze NL (see pneumonia) Sliding
Pneumonia Hyperdynamic squeeze NL or ↓ Unilateral B-lines Sliding
Decompensated HF Mod/Poor squeeze Bilateral B-lines Sliding
PE RV > LV
McConnell's sign
NL or Unilateral B-lines Sliding

Pericardial Effusion

  • For cardiac tamponade
    • Pericardial effusion
      • In acute cases, even a relatively small build up of pericardial fluid can lead to hemodynamic compromise
    • Diastolic collapse of the right atrium (in atrial diastole)
    • Diastolic collapse of the right ventricle
    • Plethoric IVC
    • Valvular pulsus parodoxus
      • Doppler interrogation across the mitral valve will demonstrate exaggerated respiratory variability of transvalvular flow

Video

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See Also

Source

Sonosite Uptodate