a clue to the problem the cardiovascular limited ultrasound examination n.gibson, i. ma
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A CLUE to the Problem
The Cardiovascular Limited Ultrasound Examination
N.Gibson , I. Ma
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Disclaimer
• No vested interests or investments other than as a purchaser
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Simple Approach
• Six areas of investigation• Validated with biochemical and angio data• 6-10 minutes with experience• Improved sensitivity compared to traditional
auscultation• Some experience and practice required – 30
minutes with medical students studied
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Cardiac Probe Positions
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1. Global LVEF
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• Normal – Mitral Valve nears or hits the septum
• Abnormal – MV > 1 cm from the septum throughout the cardiac cycle
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2. Is the Left Atrium enlarged
• Normal – LA<Ao at any time• Abnormal – LA always greater than Ao
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3. Is there Pulmonary Oedema
• Appearance of Ultrasound Lung Comets (ULC’s) or Comet tails
• Normal - none• Abnormal - > three per field• B-lines, transect thefield completely and are
pleural based
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Ultrasound lung comets.
Frassi F et al. Eur J Echocardiogr 2007;8:474-479
Copyright © 2007, The European Society of Cardiology
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Ultrasound lung comets number increases with increasing dyspnoea severity.
Frassi F et al. Eur J Echocardiogr 2007;8:474-479
Copyright © 2007, The European Society of Cardiology
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Date of download: 11/16/2012
Copyright © American College of Chest Physicians. All rights reserved.
“Ultrasound Comet-Tail Images”: A Marker Of Pulmonary Edema*: A Comparative Study With Wedge Pressure And Extravascular Lung Water
CHEST. 2005;127(5):1690-1695. doi:10.1378/chest.127.5.1690
Top, A: Typical comet-tail artifacts: hyperechogenic, coherent vertical bundles with narrow basis spreading from the transducer to the further border of the screen. This artifact is composed of multiple microreflections of the ultrasound beam. Bottom, B: Normal subject, with regular, parallel, roughly horizontal hyperechogenic lines due to the lung-wall interface.
Figure Legend:
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4. Is There Pleural Fluid
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5. Is the RV Increased
• Normal – RV < LV• Abnormal – RV > LV
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6. Is the CVP Elevated
• IVC view• Lift subcostal probe to perpendicular• Normal – small and changes with respiration• Abnormal – large and may be static• Responsiveness with respiration may suggest
fluid responsiveness
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Let’s Try It!!