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Mild LV-wall disturbance detected by speckle-pattern
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?
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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?
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Lambl's excresence?
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?
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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?
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Prominent crista and lipomatous hypertrophy of the interatrial septum
In this apical 4 chamber TTE clip, the interatrial septum is thickened consistent with lipomatous hypertrophy and there is a rounded density in the posterior right atrium consistent with a prominent crista terminalis.
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In this apical 4 chamber TTE clip, the interatrial septum is thickened consistent with lipomatous hypertrophy and there is a rounded density in the posterior right atrium consistent with a prominent crista terminalis.
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LV False tendon 2
Another example of a LV false tendon in this apical 3 chamber clip.
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Another example of a LV false tendon in this apical 3 chamber clip.
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bicuspid aortic valve ,aneurysm,dissection,coarctation
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.
Runtime: 1m:51s
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.
Runtime: 1m:51s
Haemodynamic monitoring using echocardiography: a trial 1
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.
Runtime: 0m:34s
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.
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Apical Thrombus with and without contrast
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.
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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.
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cardiogenic shock caused by thrombembolic occlusion of left main stem
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.
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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.
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septic shock caused by huge vegetation of tricuspid valve
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.
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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.
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Massive RV and RA dilation
In this apical TTE clip, the right ventricle and atrium (seen on the left side of the image) are massively enlarged.
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In this apical TTE clip, the right ventricle and atrium (seen on the left side of the image) are massively enlarged.
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TTE pulmonic valve
In this parasternal short axis TTE clip, you can see the pulmonic valve. This structure is usually not well visualized in this view.
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In this parasternal short axis TTE clip, you can see the pulmonic valve. This structure is usually not well visualized in this view.
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thrombus of left atrial auricle
about 85 y old patient with atrial fibrillation. in TEE we found a thrombus in LAA.
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about 85 y old patient with atrial fibrillation. in TEE we found a thrombus in LAA.
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common atrium
common atrium : absence of the interatrial septum with common atrioventricular valve and 2 av orifices.apical view.
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common atrium : absence of the interatrial septum with common atrioventricular valve and 2 av orifices.apical view.
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Normal mitral annuloplasty
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.
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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.
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severe pulmonary embolism
young pregnant woman (38 WOP) with dyspnoea, tachycardia was admitted from another hospital to our icu. We found the echocardiographic picture of an cute cor pulmonale with signs of decompensation. actually no catecholamines was needed. We started anticoagulation with UFH (PTT > 60 sec) and decided to do the sectio with cardiac-surgery-standby. No lysis because of possibility of ablatio of placenta.
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young pregnant woman (38 WOP) with dyspnoea, tachycardia was admitted from another hospital to our icu. We found the echocardiographic picture of an cute cor pulmonale with signs of decompensation. actually no catecholamines was needed. We started anticoagulation with UFH (PTT > 60 sec) and decided to do the sectio with cardiac-surgery-standby. No lysis because of possibility of ablatio of placenta.
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RV Collapse?
In this TTE clip, the RV doesn\'t look quite right. There is an effusion, but does the RV collapse during diastole? Review of the accompanying M-mode suggested that the relaxation was not normal, but there was no true RV diastolic collapse. No other indications of hemodynamic compromise were seen.
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In this TTE clip, the RV doesn\'t look quite right. There is an effusion, but does the RV collapse during diastole? Review of the accompanying M-mode suggested that the relaxation was not normal, but there was no true RV diastolic collapse. No other indications of hemodynamic compromise were seen.
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Pericardial effusion with fibrous strands
pericardial effusion with clear fibrin strands - Typical of TB pericardial effusion(59-46% cases in Sub-Saharan Africa). Patient was asymptomatic i.e no respiratory distress, chest pain etc. RA diastolic collapse noted, however No significant respiratory variation could be detected in MV/TV flows. Spontaneous echo contrast was noted in A4CH views.
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pericardial effusion with clear fibrin strands - Typical of TB pericardial effusion(59-46% cases in Sub-Saharan Africa). Patient was asymptomatic i.e no respiratory distress, chest pain etc. RA diastolic collapse noted, however No significant respiratory variation could be detected in MV/TV flows. Spontaneous echo contrast was noted in A4CH views.
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RV pressure overload and septal bounce
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.
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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.
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severe endocarditis of aortic-valve-prosthesis and suspicion of partial-avulsion of prosthesis
about 75 y old patient, admitted from another hospital to our ICU with new heart murmur and septic constellation. In clinical history there is a condition after aortic-valve-replacement (in the late 1990´s). In TTE we could see a distinct aortic insufficiency (verifiable in subclavian artery); for that reason we performed a TEE: it looks like a partial-avulsion of this prosthesis high suspicious for endocarditis of prosthesis. Do you confirm with this diagnosis?
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about 75 y old patient, admitted from another hospital to our ICU with new heart murmur and septic constellation. In clinical history there is a condition after aortic-valve-replacement (in the late 1990´s). In TTE we could see a distinct aortic insufficiency (verifiable in subclavian artery); for that reason we performed a TEE: it looks like a partial-avulsion of this prosthesis high suspicious for endocarditis of prosthesis. Do you confirm with this diagnosis?
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