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CARDIAC ECHO

ED Echocardiogram Pearls & Pitfalls

  • Positioning: elevate the head of bed slightly, have the patient bend their knees to get a better and less uncomfortable subcostal, view
  • Small amounts of pericardial fluid will accumulate posteriorly first under the force of gravity.
  • Findings in tamponade include diastolic right ventricular collapse
  • Pericardioscentesis: Apex is usually the #1 site, subcostal best in only 12%
  • Volume status: Use the sniff test. Visualize the IVC and have the patient make a strong sniff. If there is full collapse if the IVC, the CVP should be less than 5, if there is some collapse it is 5-10 and if there is no collapse the CVP is greater than 10.
  • A hypoechoic space seen anterior to the heart with no evidence of posterior fluid is most likely a pericardial fatpad.
  • Fluid doesn’t accumulate behind the left atrium because the pericardium is adherent there.
  • Pleural fluid can be mistaken for pericardial fluid. If uncertain, try to visualize the post-cardiac aorta; if the fluid is behind that it is likely pleural in origin.
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    Cardiac Echo

    echo-normal-heart-parasternal-view.JPG

    Echo of normal heart - Parasternal View - labeled

     

    echo-normal-heart-labeled.JPG

    Echo of normal heart - Apical View - labeled

     

    Sub xiphod echo
    Normal Heart: Sub-xyphoid veiw

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    dilated-heart.JPG

    Dilated Heart from advanced CHF

     

    cardiac echo.jpg
    Cardiac Tamponade: Malingnant
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    echocardiography.jpg
    Pericardial Effusion
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    Echo
    Amyloid Heart
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    pulmonary embolism.JPG
    Pulmonary Embolism causing dilated hypokinetic Right Ventricle

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    hpokinetic RV.jpg

    Pulmonary Embolism causing dilated hypokinetic Right Ventricle
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