Discover and read the best of Twitter Threads about #echofirst

Most recents (24)

Ecografía pulmonar 🫁. Guía fácil y práctica de como utilizarla. ABRO HILO
#POCUS #CardioEd #echofirst #ENARM #medicaleducation #ultrasound #MedEd #Cardiology Image
Es curioso porque clásicamente se decía que la ecografía pulmonar no era posible. Harrison afirmaba que " los ultrasonidos (US) se disipan rápidamente en el aire por lo que carecen de utilidad en la evaluación del parénquima pulmonar" ¿Qué ha cambiado? Image
Daniel Lichtenstein, un intensivista francés, redescubrió la ecografía pulmonar. Es cierto que los US no se transmiten bien por el aire, pero Lichtensein descubrió que pequeñas alteraciones en la relación aire-agua a nivel pulmonar formaban artefactos ecográficos característicos. Image
Read 25 tweets
It was so great to give a (virtual) talk to the Hellenic Society of Cardiology on #covid and #whycmr- hopefully next year in person with no more need 4 Covid talks! Short 🧵 on CMR use #epeeps #cardioed #echofirst #tavr #metaanalysis …/2
#covid is bad for many organs- including the heart. The role of ACE2 receptors to facilitate entry to the cells is well known! But for the heart Covid does lead to #infarction #arrhythmias #heartfailure #myopericarditis What can you do to avoid this? GET A #VACCINE
Hospitalized patients with high troponin are the sickest ones. Great study from #london hospitals showing that in this cohort - late gadolinium enhancement indicating scar (an adverse prognostic factor) is present in 1/2 patients. How to avoid it? GET A #VACCINE …4
Read 9 tweets
Post holiday season, @ICUltrasonica, @wilkinsonjonny & I are back to take you through the most most critical clinical questions on #haemodynamics that ultrasound can answer

We’re now on to question 3 of FUSIC HD

’Is the aorta abnormal?’

#FUSIC #echofirst #POCUS #FOAMus
Aortic dissection is easily missed, carries a high mortality and should be on the differential of any patient with shock, abdo pain or chest pain. Contrary to popular belief the entire aorta can be imaged via transthoracic and abdominal ultrasound. Let’s start with some anatomy
Asc aorta:
Visualised from PLAX view with depth ⬇️ & probe tilted to focus on the root. Tilting superiorly, or moving up a rib space, may help. Examine the AV and look for a dissection flap. Measure the diameter 3-4cm from the AV. The root can also be seen from A5C & A3C views
Read 20 tweets
You are asked to preoperatively assess a patient with known primary severe mitral regurgitation for an hip replacement

Which of the following new findings might result in you postponing surgery:

Dilated LV
Impaired LV sys fxn
Pulmonary HTN
New Afib Image


Any/all of the above

If known severe MR – these are the NEW findings that should prompt you to speak to you friendly cardiologist colleagues Image

Valvular Heart Dx (VHD) AHA guidelines : Image
Read 9 tweets
1/13 - GUH Echo tweetorial:

The tricuspid regurgitation jet velocity shown was used in a critical care patient to estimate RV systolic pressure:
Vol control – tvol 420ml PEEP 10cmH20
Cardiovascular: MAP 67mmHg on Noradrenaline 0.3mcg/kg/min
His TRVmax is high:
Why should I not diagnose this patient with pulmonary hypertension in my echo report?

2 are correct:
a. not steady state
b. Off axis cursor
c. Echo cannot diagnose it
d. Poor 2D view
a, c and possibly b!

Lets start with what TR vmax means and how it is calculated
Read 14 tweets
GUH Images in Anaesthesia and ICU:

The tricuspid regurgitation jet velocity shown was used in a critical care patient to estimate RV systolic pressure:

Vol control – tvol 420ml PEEP 10cmH20

Cardiovascular: MAP 67mmHg on Noradrenaline 0.3mcg/kg/min
His TR Vmax suggests his RV systolic pressure is 51mmHg + RA pressure = HIGH

I am conscious that I should not diagnose this patient with pulmonary hypertension in my echo report:

Read 4 tweets
I'm pleased to share our newest article ( in @JournalASEcho led by @BIDPlymouth lead sonographer @FostelloS who spearheaded a weekly #EchoFirst #QI sonographer performance feedback program. @ASE360 @GWhalleyPhD @MerriBremer @BonitaEcho @IACaccred @TheSDMS
1/ Increasing imaging volume has put a unique strain on sonographers who are asked to acquire more complex studies and perform detailed analysis in the same or less time. This may contribute to misdiagnosis or errors in data entry that may prolong time needed to analyze studies.
2/ We evaluated a system of weekly sonographer performance feedback on rates of errors. Physicians were mandated to evaluate sonographer performance on 26 technical errors and 17 scan omissions, 2018-2020 using the customizable @EncaptureMD #EchoFirst reporting software.
Read 16 tweets
The JVP exam has been with us since 1930 when Sir Thomas Lewis first proposed this exceptionally clever technique. A #pocus thread. Image
He knew that in heart failure there in “congestion of the veins” and when they become engorged can be detected on the neck.
Here is a phenomenal example in a very thin patient with prominent veins.
Read 10 tweets
One of my favorite and most intriguing causes of severe venous congestion (#VExUS = 3)

A 🧵on High Output Heart Failure (HOHF) 1/18
First, the index case:

Clip above shows hyperdynamic flow from the vena cava

#echofirst 👇: Very dilated and plethoric IVC, LV OK, Dilated RV, D sign

Overall: Increased Right heart filling pressures

IVC = 3.4 cm
Portal Vein = > 100% pulsatility
TRVmax = 3.04 m/s

So we have:

Venous Congestion (IVC, Portal Vein)
High Cardiac Output (LVOT-VTI)
Pulmonary Hypertension (TRVmax)

Read 18 tweets
Educational Thread (longish) on AORTIC STENOSIS on the new #ESCGuidelines #ESCCongress published at @escardio #EHJ… Another thread to follow on AR. So truly excited about these guidelines and here’s why @mirvatalasnag @mmamas1973 @DrMarthaGulati @Hragy …/2
First things first #ESCCongress - a patient centered approach recommended. 👏 but I thought we had long moved to a patient centred approach but nonetheless good to highlight #epeeps #cardio #echofirst #whycmr …/3
#ESCCongress valve guidelines - and the role of the Heart Team re- emphasized. This is crucial. But also defining who should be present to constitute a ‘Heart Team’ @milena_mate @MelissaLyleMD @drzgezdentok1 @AScatteia @RositaZakeri @pacman8it @dr_benoy_n_shah @tchaaban1 …/4
Read 11 tweets
#ESCCongress #ESCGuidelines This is a Long thread on Heart Failure Guidelines published @escardio #EHJ… LONG BUT EDUCATIONAL! Focus on CHRONIC HF #epeeps #CardioEd @AlexFrogoudaki @mmamas1973 @DrMarthaGulati @purviparwani @Filippatos @EkateriniL @Hragy …/2
#ESCCongress Firstly, no longer Mid Range, replace by MILDLY REDUCED LV EF. Makes a lot of sense - in fact for some time I thought the previous guidelines referred to ‘mildly reduced’ until @merinopoulos corrected me… otherwise no real change in the nomeculture …/3
#ESCCongress nice algorithm - assess risk factors… do BNPs (watch the caveats- AF ⬆️ , obesity ⬇️ value so bear this in mind. The #echofirst and classification into Reduced, mildly Reduced and Preserved. @SineadHughes19 @wordfinga @rahatheart1 @HEARTinMagnet @bp_halliday …/4
Read 12 tweets
1/ Our paper on pre- and post ejection tissue velocities by #EchoFirst in relation to valve closures and openings is out:…
2/ 22 healthy subjects, Valve openings and closures timed by Doppler flow, and transewfrred to Tissue Doppler recordings. Image
3/ Pre ejection velocities started 24.8 ms after start QRS, with a duration of 51.5 ms, ending about 11.5 ms after MVC. Thus, both electromechanical delay and pre ejection velocity occurs *before* onset of IVC, and are not a measure of IVC or Isovolumic acceleration. Image
Read 12 tweets
Ok, it's #Tweetorial time. Today's topic: echo formulae. Specifically AVA and PISA. They oft cause angst and confusion among trainees so here's a quick primer on these #EchoFirst essentials...1/20...
2/20, Both rely on the Law of Conservation of Mass. Basically - amount of blood in = amount of blood out...
3/20, Aortic valve area and mitral regurgitant area (and subsequently volume) can be calculated using the "continuity equation" relying on this fundamental law of physics...
Read 20 tweets
We’ve seen how to measure VTI and stroke volume with #ultrasound
Our next #FUSIC haemodynamic question brought to you by @icultrasonica, @wilkinsonjonny and I is:

Q2. Does SV respond to fluid, vasopressors or inotropes?

#echofirst #POCUS #haemodynamics #foamed
In Q1 we saw how to measure stroke volume (SV). Q2 helps us manage someone with an inappropriately low SV. Pressors, fluids and inotropes are all treatment options. If If used correctly, they will ↑SV. If not, they won’t, and they may even be harmful.
Measuring VTI before and after each of these interventions will therefore easily show you if they have worked. But can we predict which one is likely to work before we give drugs or a drop of fluid? 1st, let’s go back to some physiology.
Read 25 tweets
GUH - Echo Tweetorial - Aortic Stenosis:

How do they calculate:
1. Valve area
2. Mean AV gradient
3. Max AV gradient
Essential Principles:
1. The effective orifice area is always smaller than the anatomical orifice area
This effective orifice area is what is calculated
It is the key determinant of survival
2. Continuity equation
Conservation of mass
Continuity equation:
A2 X V2 = A1 x V1
Read 15 tweets
GUH - images in Anaesthesia and ICU:
In anticipation of our Level 2 echo tweetorial series

This is a zoomed image of a valve during a level 2 scan

1. Name the valve
Name the valve:
For bonus points -

Name the transthoracic echo view:
Read 11 tweets
What are the key clinical questions about haemodynamics that ultrasound can answer?

@icmteaching, @wilkinsonjonny and I are going to take you through the 10 most important…

starting with...

Q1. Is stroke volume abnormal?

#FUSIC #echofirst #POCUS #ultrasound #haemodynamics
Despite shock being such an important diagnosis, intensive care clinicians are rubbish at detecting a low or high cardiac output (CO) clinically.

Sensitivity of detecting cardiac index (CI) < 2 clinically in this study was 0!…
From an apical 5- or 3-chamber view we can use PW Doppler to assess the velocity time integral (VTI) in the LVOT to determine blood flow.

Essentially, LVOT VTI is the average distance travelled by ejected blood during one contraction...

It is also known as stroke distance.
Read 12 tweets
Nice Tips:
Assessment of prosthetic Valves
From the current ESC Guidelines: acute aortic syndrome, risk stratification and practical stepwise approach #echofirst
Read 5 tweets
"washing machine" 🌀
Severe TR
Read 7 tweets
1/How can #POCUS #echofirst help in the evaluation of #hyponatremia?
#Nephrology consulted for low sodium. Pt received diuretic for shortness of breath (which was possibly due to hiatal hernia as shown on CXR).
2 physicians FELT patient was EUVOLEMIC
Small 🧵below 👇 #MedEd Image
2/Based on the above labs, it does look like euvolemic hyponatremia (Urine Na is high, Uosm >100 but not too high, BUN not high). BP was 150s systolic.
That's it? Give some salt tablets or UreNa etc.?
No; perform PHYSICAL EXAM (= #POCUS)
IVC was small - doesn't tell much 😬
3/ Next step? Look at the heart, assess stoke volume.
Recent echo LVEF>50%
LV contraction looks good visually
We measured LVOT VTI (couldn't measure LVOT diameter due to chest deformity precluding good PLAX view but its not a problem; VTI is generally enough)
#POCUS Image
Read 10 tweets
1. This month's #EHJCaseReports #tweetorial focuses on a cardiac condition that can result in these findings 👇 on #echofirst. What could it be?
1 Hypertension
2 Hypertrophic cardiomyopathy
3 Aortic stenosis
4 Cardiac amyloidosis…
#CardioTwitter @EHJCREiC
2. It’s cardiac amyloidosis! Here is a great resource from @escardio WG on Myocardial and Pericardial Diseases to start with…
3. First, what is amyloidosis?

Amyloidosis occurs when abnormal proteins misfold and deposit in tissues as beta-pleated sheets. These disrupt tissue structure and can cause damage to many different organs.
Read 27 tweets
#MacHF Dr Eilliam McIntyre on when to choose warfarin over a DOAC
@hvanspall @DrRajivsankar @rachkataria @aayshacader @vbluml @paomorejon @lucreciamburgos @KevinShahMD
#MacHF the triad of obesity, HFpEF and AFib. All@of us have seen these challenging patients. Dr Jorge Wong shares some tips about how to treat them @hvanspall @DrRajivsankar @rachkataria @aayshacader @vbluml @paomorejon @lucreciamburgos @KevinShahMD
Read 29 tweets
#POCUS #echofirst #MedEd case of the day.
Context: alcoholic liver cirrhosis with suspected #hepatorenal syndrome
Purpose: think about the underlying pathophysiology & seek expert input
1/ PLAX, PSAX, Apical views of the heart. Heart rate ~110-116 bpm
#VExUS images in 🧵
2/ overall, looks hyperdynamic. LA looks little enlarged on PLAX, visual TAPSE high on apical.
In cirrhosis, hyperdynamic circulation is expected because of splanchnic vasodilatation and 'relative' arterial under filling.
LV EF #POCUS obtained using @kosmosplatform 👇
3/ Lets calculate stroke volume using LVOT VTI #POCUS
It looks supra-normal
Read 20 tweets
What are your pearls for assessing the mechanism & severity of #mitralregurgitation by #EchoFirst?

#JACCIMG presents an imaging-based curriculum to review functional #mitralvalve regurgitation for #CardioTwitter.

Follow/share this #Tweetorial! (1/15)
#JACCIMG Tweetorial Mitral regurgitation (2/15)

Case 1: What is the pathology shown?
JACCIMG #Tweetorial (3/15)

Shown is an example of flail leaflet of the #mitralvalve at the P2 segment.

Surgical #mitralvalve repair is the gold standard; due to prohibitive risk, the patient underwent successful percutaneous repair #TMVR, guided by 3D #EchoFirst.
Read 15 tweets

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