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 of normal heart - Parasternal View - labeled
Echo of normal heart - Apical View - labeled
Normal Heart: Sub-xyphoid veiw
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Dilated Heart from advanced CHF
Cardiac Tamponade: Malingnant
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Pericardial Effusion
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Amyloid Heart
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Pulmonary Embolism causing dilated hypokinetic Right Ventricle
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Pulmonary Embolism causing dilated hypokinetic Right Ventricle
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