Cardiac EDE

Question 1

Criteria for adequate subxiphoid view

Answer 1

7 sign
inferior pericardium visualized
apex seen
liver

Question 2

Trouble shooting subxiphoid view

Answer 2

lying down, deep breath and hold it, knees up/flex hips

Question 3

troubleshooting precordial views

Answer 3

breathing, turn to left lateral decubitus

Question 4

Sizing a pericardial effusion

Answer 4

<1cm: small, seen inferiorly/posteriorly depending on view
1-2cm: medium sized; can seen circumferentially
>2cm: massive pericardial effusion, seen circumferentially.

Question 5

differentiating epicardial fat pad from pericardial effusion

Answer 5

MESA
Moves with heart
Echogenic (not just black like an effusion)
Subxiphoid view visualized
Seen more anteriorly.

Question 6

EF of hyperdynamic heart

Answer 6

70

Question 7

normal EF

Answer 7

50-70

Question 8

mild-moderately reduced EF

Answer 8

30-49%

Question 9

severely reduced EF

Answer 9

<30%

Question 10

What to look for in global cardiac assessment

Answer 10

LV dilation
Myocardial thickening
Endocardial excursion

Question 11

E Point septal separation

Answer 11

Assessment of anterior mitral leaflet (LV) to see how it slaps the interventricular septum. Must come within .7cm of the interventricular septum to see if it has normal contractility. If it doesn’t make it remotely close to the septum, the contractility of the LV is likely reduced.

Question 12

When does E Point Septal Separation (EPSS) overestimate and underestimate EF

Answer 12

Overestimate: mitral stenosis, mitral calcification, aortic regurgitation

Underestimate: off centre measurements, mitral regurgitation, septal hypertrophy, LVH.

Question 13

Acute and chronic causes of RV Dysfunction

Answer 13

Acute: PE, RV infarction, RV trauma
Chronic: Pulmonary HTN (CHF, OSA, COPD)
valvular insufficiency (TR, PR, PS), cardiomyopathy, ASD.

Question 14

TF: POCUS can rule out a PE

Answer 14

false. It can help rule in acute PE (Ie, RV strain such as D sign or intraventricular septum deviation), but never rule out

Question 15

tamponade diagnosis is __, using becks triad.

Answer 15

Clinical
Becks triad; muffled heart sounds, distended JVP, hypotension

Question 16

A lines are ___ artifact between __ and __. It can be seen in normal aerated lung, but does not mean normal lung.

Answer 16

A lines are REVERBERATION artifact between PLEURA and SKIN. It can be seen in normal aerated lung, but does not mean normal lung.

Question 17

How do B lines differentiate between comet tails

Answer 17

B lines are deeper

Question 18

B lines look like __ which go from the pleura to over 15cm deeps. They are ____ with lung movements and ___ A LINES. More than ____ in one intercostal space is abnormal, and indicates ____ in the alveoli.

Answer 18

B lines look like SPOTLIGHTS which go from the pleura to over 15cm deeps. They are SYNCHRONUS with lung movements and OBSCURES A LINES. More than 3 in one intercostal space is abnormal, and indicates FLUID in the alveoli.

Question 19

ddx for symmetrical vs asymmetric B lines.

Answer 19

symmetrical: CHF/pulmonary edema, fibrosis
Asymmetrical: ARDS, pNA, Pulmonary contusion/hemorrhage, COVID.

Question 20

COMET TAILS are aka ___ lines

Answer 20

z lines, they are ill defined vertical lines that are short and disappear after 2-4 cm. They do not obscure A lines and move independent of the lung. they are of no clinical significance.

Question 21

Distinguishing Aorta vs IVC

Answer 21

Aorta: No respiratory variation, No compressibility, Thicker Echogenic wall
Less reliable: orientation, pulsatility.

Question 22

aorta scan boundaries

Answer 22

visualize the entire aorta from the diaphragm to the bifurcation.

Question 23

abnormal aorta diameters

Answer 23

aorta >3cm = AAA, aorta <5.5cm = high risk.

Question 24

Pericardial effusions can be seen in multiple views, with the exception of:

Answer 24

cardiac surgery patietns.d

Question 25

describe the normal RV in A4c view

Answer 25

traingular in shape
LV 60% of the view
Apex is LV dominant
Thinner wall.