This is a trial: haemodynamic measurements/ results by echocardiography in comparison with PA-cath-results. about 75 y old patient with cardiogenic shock by occlusion of RCA. Echocardiographic results: 1. contractility by mv-insufficiency: dp/dt about 320 mmHg/s (this shows a distinct impairment of left ventricle). 2. an approach to LVEDP by E/E`: about 12,7 mmHg 3. approach to CVP alternatively RAP: collapsibility of IVC: one can see, that there is no undulation/ collapsibility of IVC, diameter of IVC > 2 cm: RAP about 15-20 mmHg 4. approach to cardiac output: LVOT-VTI about 23,5 cm, LVOT-area 1,53 cm^2 (radius 0,7 cm) > stroke volume about 36 ml; heart rate: 110/min > cardiac aoutout about 3,9 l/min 5. tricupid valve (TV): Vmax: 3,4 m/sec, PAPs 35 mmHg + CVP; ATC of PV-flow 89 msec, PV-VTI 12,3 cm, one can calculates the PVR with two methods: > a. PVR= TV-flow velocity/ VTI of RVOT x 10 + 0,16; in this case you can calculate: PVR= 3,4 m/s / 0,125 m x 10 + 0,16 = 276 dyn*s*cm^-5 > b. PVR= (PAPm-PCWP)/CO x 79,9; in this case I couldn´t measure the PAPm and PAPd because I couldn´t depict a PV-insufficiency-signal by echocardiography. In comparison: the PA-cath-results: PCWP (LVEDP) 13-14 mmHg, CVP 19 mmHg, CO 4,3-4,5 l/min, PVR 285 dyn*s*cm^-5, SVR 890 dyn*s*cm^-5, cardiac power 0,71 W In my opinion is echocardiographic measurements of a few parameters a good option to approach haemodynamic in patient and to make a fast decision of therapeutical treatment in ER or ICU. I´m lookinf forward to any comment, hints, tipps and critic. That could help me to improve my skills in that kind of echocardiographic technique.

Added by: Emmel
Tags: TTE ICU echodynamic haemodynamic PA-cath
Date: 2012-01-29

about 60 y old patient with condition after operation of carcinoma of pancreas and chemotherapy. Actually the patient was admitted to our ER with severe oedema of lower limbs: no thromboses of IVC or deep lower veins of both legs or V. iliacae. We found a severe lack of proteins, especially of albumin. The patient was hypoton, tachycardiac and weak. No fever, no new heart murmur. in TTE I found a hyperdynamic heart. Approach to cardiac output demonstrated a cardiac output of about 11,2 l/min (LVOT-diameter 19 mm, LVOT-VTI 42 cm, LVOT-velocity 1,76 m/s, heart rate 96-110/min). There was a increase of flow in aortic valve looking like low-grade aortic stenosis, but the dimensionsless index was near 1,0 (0,97) showing that there is no aortic stenosis (AV Vmax 2,2 m/s, PGmean 11,2 mmHg). There was also a midventricular gradient and distinct collaps of IVC; LVOT-VTI-variation was > 13% (I used that variation instead of delta pulse pressure-variation, because I did that echocardiography before tapping an artery) There wasn´t an incease of LVEDP (E/A 0,88, E/E`about 6 mmHg, velocitiy-prolongation about 0,37 - 0,42 m/s, E´-velocity 0,15 m/s). No us-b-lines or effusion of pleura. After fluid-challenge despite of the severe oedema there was a stabilisation of haemodynamic.

Added by: Emmel
Tags: TTE ICU ER haemodynamic sepsis
Date: 2012-02-18

previously I have posted some elementary images from this case.Now I upload the complete clip including:bicuspid aortic valve (with mild eccentric aortic regurgitatio),aneurysm of the ascending aorta,type A dissection,atrial septal aneurysm and coarctation of the aorta.

Added by: magehana47
Tags: bicuspid aorta valve dissection atrial septal aneurysm coarctation
Date: 2012-02-07

About 45 y old patient with the typical clinical afflictions of acute coronary syndrom. in TTE I couldn´t see a LV-wall-motion-disorder. In Speckle-tracking/-pattern study I found a mild LV-wall-motion-disturbance. Troponin was positive. In coronary study we found a high-grade stenosis of RIVA compatible with the results of speckle-pattern-study. What do you think? Does anybody have any experiences with that kind of stuff? Is it a suitable kind of study?

Added by: Emmel
Tags: TTE ER infarction RIVA-occlusion speckle pattern
Date: 2012-03-09

In this apical TTE clip, the right ventricle and atrium (seen on the left side of the image) are massively enlarged.

Added by: drdavemd
Tags: TTE right ventricle atrium massive enlargement dilation dilatation
Date: 2012-01-11

young patient with septic shock. intravenous drug consumption is known. in TTE we found a huge endocarditic vegetation on tricuspid valve. in TEE we could verified this, no vegetations on mitral, aortic or pulmonary valve. beside we could see multiple small pulmonary abscesses caused by bacterial embolizations.

Added by: Emmel
Tags: TEE endocarditis tricuspid valve ICU septic shock
Date: 2012-01-15

about 75 y old patient with STEMI and about 45 minutes cpr. the patient was admitted from our ER after cardiac catheter to our ICU. In cardiac catheter we found a thrombotic occlusion of left main stem, no plaques and no stenosis. in clinical history a permanent atrial fibrillation with condition after several thrombembolic strokes is known. in TEE we found a distinct cardiac wall movement disorder of left ventricle and a small parietal residual of thrombus in LAA. we think that a thrombembolic cardiac infarction caused by thrombus in LAA is the most plausible reason of this finding.

Added by: Emmel
Tags: TEE cardiogenic shock STEMI ICU
Date: 2012-01-17

An extended TTE should include a simple view of thoracic ECHO. Place the transducer in both parasternal higher intercostals spaces, look at the pleural line and look if ultrasound B lines are present (US B lines represent abnormal extravascular lung water, although is not strictly specific for this pathology, for example, we can encounter B lines in pulmonary fibrosis, ARDS and pulmonary contusions). In right clinical context, with echocardiography in doubt, US B lines identifies patients with lung edema and finally define diastolic disfunction. When acute respiratory failure is the diagnosis, in right clinical context, the absence of US B lines excludes a cardiogenic cause. In patients with proven diastolic disfunction, identifies lung edema and helps to intensify therapeutic options./nSo...it is very simple to do.!

Added by: ohtusabes
Tags: lung edema
Date: 2012-01-28

Scroll down for all the findings in this clip.

Added by: drdavemd
Tags: cardiology board review
Date: 2011-12-21

In this side-by-side pair of transthoracic apical clips, a thrombus is clearly visualized in the LV apex. The left image is without contrast and the right image is with echo contrast.

Added by: drdavemd
Tags: echo contrast TTE apical thrombus
Date: 2012-01-18

about 50 y old patient with dyspnoea and new diagnosed atrial fibrillation. In TTE we found a distinct decrease of myocardial function. In cardiac catheter there is no coronary disease. Approach to cardiac output by echocardiography: about 3,2 - 3,5 l/min.

Added by: Emmel
Tags: TTE DCM
Date: 2012-02-18

In this zoom view of the aortic valve in parasternal long axis TTE, a small filamentous structure is visible on the ventricular side of the valve. Would you characterize this as a Lambl's excresence or would you even comment on it in a report?

Added by: drdavemd
Tags: Lambl's excresence aortic valve
Date: 2012-03-07

common atrium : absence of the interatrial septum with common atrioventricular valve and 2 av orifices.apical view.

Added by: magehana47
Tags: common atrium congenital
Date: 2011-12-28

about 85 y old patient with atrial fibrillation. in TEE we found a thrombus in LAA.

Added by: Emmel
Tags: thrombus TEE ICU LAA
Date: 2012-01-01

About 50 y old patient with atrial fibrillation (HR about 150-170/min); the patient told clinical afflictions in the course of time of 3 weeks. In TTE we found a distinct LV-motion disorder and decrease of LV-EF. After exclusion of thrombus in LAA by TEE we did the elektrical cardioversion. After 1 week we saw a distinct improvement of LV-function.

Added by: Emmel
Tags: TTE ER ICUTachy-Cardiomyopathy
Date: 2012-03-09

A man in his 40s presents with an new onset heart failure, severe HTN (SBP ~240) and this mass in his LV. What could it be? Is it thrombus?

Added by: drdavemd
Tags: unknown ventricular mass hyperechoic
Date: 2009-04-28

In this parasternal short axis transthoracic clip, you can see the D shape of the LV common in patients with RV pressure overload. The IV septum also bounces in this particular patient with a history of sternotomy for aortic valve replacement.

Added by: drdavemd
Tags: tte parasternal short RVP post-op
Date: 2011-12-07

In this transthoracic parasternal long axis clip, there is an echodense structure at the base of the mitral valve. Sometimes confused for mitral annular calcification, in this patient the density is a normally functioning mitral annuloplasty ring. LV function is normal.

Added by: drdavemd
Tags: transthoracic parasternal long axis TTE normal mitral annuloplasty
Date: 2011-12-28

Another example of a LV false tendon in this apical 3 chamber clip.

Added by: drdavemd
Tags: TTE apical left ventricle false tendon
Date: 2012-02-29

pericardial effusion with fibrinous strands,apical view.etiology:tuberculosis.

Added by: magehana47
Tags: pericardial effusion pericarditis fibrinous strands tuberculosis
Date: 2012-03-17