Enrich your knowledge of cardiac ultrasound with the help from experienced sonographer, Sharon Kay. Sharon covers a focused cardiac ultrasound of the heart, and gives examples of emergency cardiac conditions that can be detected with this versatile modality. This talk was recorded at Bedside Critical Care Conference 4. For the full post and other BCC4 posts, head over to www.intensivecarenetwork.com

1. The Focused
Echocardiographic
Examination
Sharon Kay PhD
MSc (Perfusion)
MSc (echocardiography)
BSc

2. The Heart revealed
• 5 different tools / modalities are used in
every day cardiac echo

3. 3D echo Spectral Doppler
Colour Doppler
2D echo
Strain / speckle track

4. The Heart revealed
• 5 different tools / modalities are used in
every day cardiac echo
• It will take years of training > 5, multiple
scans > 4000 to become an expert and
be able to exclude things
• THIS IS NOT WHAT BCC / EFOCUS /
Rapid cardiac assessment IS!

5. The Heart revealed - EFOCUS
Arm to your clinical medicine – BE A DR
Helping strengthen your impressions
Not a diagnostic tool or fishing expedition

6. The Heart revealed - EFOCUS
EFOCUS
FEEL
LIMITED ECHOWINFOCUS
FATE
RACE EFAST
BEDSIDE SONO

7. FATE CARD - Android / IPhone

8. FATE

9. Subcostal long axis

10. Subxiphoid long axis

11. Subxiphoid Short

12. Subxiphoid IVC

13. Parasternal long axis

14.  Parasternal short axis - LV

15. Parasternal short axis -
Valves

16. Apical 4 chamber

17. The Heart revealed
S Size
M Movement
A Artefacts
C Comparison
C Consistency

18. Normal Dilated

19.  RV Dilated  LV Dilated

20. Subcostal Aorta

21. LVEF
Mildly reduced

22. Moderate global dysfunction

23. Severely reduced

24. AMI - segmental
Inferolateral MI

25. CHAMBERS
• Size
• Compare chambers LV to RV
• Ventricles to atria
• All 4 chambers remodel in size
depending on pathology present
• eg: PHT / Aortic incompetence /
pressure

26. CHAMBERS
• Size
• Wall thickness (or thinness)
• Hypertrophy – hypertension
systemic or pulmonary
• Deposits – sarcoid / amyloid /
HOCM

27. CHAMBERS
• Movement – Function Compare
• Fractional shortening – the squeeze
of the Ventricle
• Global – Cardiomyopathy –
• ETOH / myocarditis
• Athletes
• Segmental – AMI / IHD /
• Tako Tsubo (not without and Cath)

28. CHAMBERS
• The atria
• Size ( LA – dilated ? why)
• Diastolic dysfunction / regurgitation /
stenosis / PVR?
• IAS – hypermobile / aneurysmal / PFO /
Not just filling pressure …… Movement
• Masses
• Thrombus / SEC / myxoma / Artifact

29. Apical 5 chamber

30. Apical 2 chamber

31. Apical long axis

32. DIASTOLOGY - FILLING PRESSURES
• Diastology
• Normal
• Normal for age, without LA dilatation
• Impaired relaxation with normal filling pressures
• Impaired relaxation with elevated filling pressures
• Decrease in LV compliance
• Pseudo normalization - Moderate
• Reversible restrictive - Marked
• Irreversible restrictive – Severe
• Constrictive

33. Pericardial effusion

34. Pulmonary hypertension

35.  Haematoma

36. Masses
LA myxoma

37. VALVES
Stenosis - Movement
Artifact
Are the leaflets mobile –
Comparison moving similar to
same
Lunar valves and AV valve

38. Aortic stenosis

39. Mitral stenosis

40. CASE STUDY

48. CASE STUDY

49. The heart revealed
S – Size
M - Movement
A - Artefacts
C - Comparison
C - Consistency