Question 1 : Assessment of fluid status with ECHO

Question 1 A haemodynamically decompensating patient requires assessment of the intravascular fluid status. Describe the Doppler echo cardiographic methods that can assist outlining the supportive evidence for their use, in addition to any obvious limitations in their application Assessment of fluid status can be achieved by using the LVOT VTI as a surrogate for stroke Read more about Question 1 : Assessment of fluid status with ECHO[…]

Question 2 : Pericardial disease

Question 2. Discuss the use and value of echocardiography in evaluating pericardial disease of various types Value is to look at the pericardium for structural abnormalities (thickening/calcification), assess associated pericardial effusions (may have strands suggesting inflammatory more chronic problem, may be anechoic, may show swirling cells) , look for haemodynamic signs of pericardial constriction. Pericardial Read more about Question 2 : Pericardial disease[…]

Question 3 : Complications of myocardial infarction

Discuss the use of Echocardiography/Doppler in the assessment of the complications of acute myocardial infarction Acute/subacute complications Cardiogenic shock Thrombus formation Myocardial rupture Papillary muscle rupture Ischaemic ventricular septum defect Chronic Remodelling of the heart Aneurysm Right heart failure Late thrombus Mitral regurgitation Assessment using ECHO Regional wall abnormalities Will depend on size and coronary Read more about Question 3 : Complications of myocardial infarction[…]

Question 4 : Severe back pain

Question 4  A 45 year old presents with sudden onset of severe acute central chest and back pain suggestive of acute dissection. Discuss the role of transthoracic and transoesophageal echo –cardiography in the initial assessment and ongoing management Role of ECHO in initial assessment: Differentiate between aortic dissection and other causes of chest pain such Read more about Question 4 : Severe back pain[…]

Question 5: septic shock

Describe the echocardiographic features not uncommonly seen in the patient with septic shock 1. ECHO exam may be normal 2. Septic cardiomyopathy: Left ventricular dilatation : if  LV EDD > 5.5cm however dependent of size of patient. If patient is an athlete LVEDD may be increased and normal.   Measure in PLAX view using calipers – Read more about Question 5: septic shock[…]

Question 6: Right heart strain

Question 6 A pt presents with breathlessness : Describe the ultrasound findings that would suggest right heart strain and what features would suggest the findings is either acute or chronic ECHO findings suggestive of Right heart strain is TR velocity > 3.4m/s SPAP > 50 MmHg with or without additional echocardiographic variable suggestive of PH Read more about Question 6: Right heart strain[…]

Question 7 : Pericardial effusion

Question 7 Describe the possible echo findings in a patient with pericardial effusion 1. Distribution Circumferential Loculated 2. Echogenicity Anechoic Echoic depending on it’s composition (blood may be echoic, pus also) May be associated with fibrin strains if chronic 3. Size small < 1cm moderate 1 cm – 2 cm large > 2 mm Measurement Read more about Question 7 : Pericardial effusion[…]

Question 8 : ECHO 2 days post AMI

Question 8 A 50 year old man presents 2 days post AMI with hypotension. You are about to scan him looking for a cause. Outline possible ultrasound findings 1. Global LV regional abnormality Reduced fractional shortening of LV . Not accurate in regional wall abnormalities/aneurysms/ LBBB Simpson’s method 4 and 2 chamber views assesses cardiac Read more about Question 8 : ECHO 2 days post AMI[…]

Question 9: Assessment of LV function

Question 9 How can  ECHO be used to assess LV function? LV function can be assessed in the following ways Fractional shortening “Eyeballing“ of LVF Ejection fraction (EF) – Simpson method Stroke volume Systolic index of contractility dP/dt Longitudinal contraction using tissue Doppler  MAPSE 1. Fractional shortening: Measures the “squeeze “ of the LV . Read more about Question 9: Assessment of LV function[…]

Question 10: Ultrasound in cardiac arrest

A 45 year old patient presents in cardiac arrest . What is the ultrasound approach to this patient? The approach to the patient in cardiac arrest is based on assessing the 4 F’s  (fluid, form, function and filling) of the heart to assess for potentially reversible causes of cardiac arrest, prognosis and to guide treatment(1) Read more about Question 10: Ultrasound in cardiac arrest[…]