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Putting it All Together - Your first Echocardiographic exam

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Transcript

Welcome to the final lecture and of course, putting it all together. In each of the previous lectures we learned how to assess one aspect of cardiac structure and function. In this lecture, we're going to put together everything we've learned and lay down a systematic approach to use when performing an echocardiogram. Being systematic helps you be quick and at the same time not forget anything. Let's get started. assume you've already selected your probe and switch to the cardiovascular reset.

Never start an exam without entering patient data. God knows how many exams I lost that way. The first view is always the left pair sternal. Adjust your debt and adjust your game. Inspect the ventricle for dilatation hypertrophy systolic function by eyeballing and regional wall motion abnormalities in the intracellular and posterior walls. Inspect the left atrium for size and for thrombi.

Measure the left atrium in ascending aorta using caliper after freezing the image for that for about their size. Examine the mitral and aortic valves for thickening excessive or restricted motion and mouth lactation. Now save the image I'll save your exams for later viewing. Next, use em mode to obtain a trace of the Lv as we discussed before, making sure to be perpendicular to the long axis of the Lv. Open the measurement pane and perform an Lv study using the cycles method. then compare your measurements against the normal values.

When your measurements are done, save the image. Now go back to 2d mode 2d mode and turn on color Doppler. Place the color box over the mitral valve and look for abnormal flow. Save the image now bring it over to the aortic valve and do the same onto the short axis rotate your probe clockwise by 90 degrees. Start with a basal Lv level exam the mitral valve is above and inspect the Lv walls for our for our w Ma. Save the image.

Now tilt your probe quarterly a bit to look at the mid capillary level. Look for our w Ma and I'm all systolic function. Save the image more quarterly a typical level, save the image not so criminally all the way up until you have the great vessel level examine the aortic tricuspid and pulmonary valves by 2d save image, examine them by color doctor. Save the images. interrogate the tricuspid valve and the pulmonary valves with continuous wave Doppler. Save the images.

Move on to the APR mendo APR 14 review, inspect the Lv for systolic function or w Ma and from by the apex save the image perform a Simpson study of the Lv function is doubtful and save the image color Doppler over the mitral valve look for abnormal flow save if the valve looks demotic use continuous wave Doppler to estimate severity. If there is visible regurgitation assess severity as discussed before, save all images color on the intro ventricular septal to check for defects. Move on to the RV measure diameters safe mode on the latter lateral annulus for tap see save color on tricuspid valve save continuous wave on tricuspid valve and measure the gradient save. Tilt the product to get the ethical five chamber view color on the car To save continuous wave Doppler on the aorta and trace to measure gradients save now possibly on the LVT trace measure save twist the probe counterclockwise 90 degrees to get the APR to chamber view confirm region almost all motion abnormalities if previously noticed in the anterior and inferior walls save color on micro sometimes eccentric Mr. Jess will be better visualized in this view.

Save was the pro more to get the typical three chamber view our w MA in the intercept and posterior walls color on aortic valve save. Lastly, the sub costal window. Sub Costco for chamber view provides any previous findings if necessary, and plays color Doppler plays color on the inter atrial septum to check for defects. Save the image. Now rotate the probe counterclockwise 90 degrees to get the IVC view. Measure the IVC and assess for inspire Tory variation to estimate rip and calculate from nary artery systolic pressure safe Notice that you don't always have to perform all of these steps.

In every patient. In some patients, you just want to look at something specific and you will perform a more focused if cartographic study. But if you have time, this is what you should do. That's it. Now it's time to report your findings. There are a lot of formats for full and rapid echo studies.

Here's a very simple one. First report on Lv size and systolic function. So you're going to say, normal or dilated or hypertrophied, Lv, and normal or impaired systolic function, estimated ejection fraction, and percent by eyeballing or titles or Simpsons method. Next comment on regional wall motion abnormalities. So you can say no rW Ma, or hypo can easily have bezel and mid inferior segments with a kinesia bezel infra lateral segments. Next, comment on valves.

So you can say moderate Mr. You can Severe as mentioned gradients and Eric valve area with mild AR. Next comment on RV size and function. So we're gonna say dilated RV with impaired systolic function and mentioned the taxi. Then comment on the pulmonary artery pressure, moderate pulmonary hypertension and mentioned the estimated pulmonary artery systolic pressure. mention any other abnormal findings as seen, for example, an Lv atypical thrombus is seen measuring and by an centimeters and never forget to include the date. This brings us to the end of this lecture and the end of our course.

I hope you've enjoyed it and found it useful. Remember that we've only scratched the surface here. A detailed account of echocardiography can feel volumes, but this course is enough for you to get by, or to get started if you're planning on going further. And in that case, I placed the link to a post in which you'll find useful information about additional resources for access Go. I've placed it in the resources section for this lecture. Well, I guess this is goodbye.

Go save lives and have fun doing it.

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