Discover and read the best of Twitter Threads about #echofist
Most recents (2)
Young ♀️ w CKD on HD, seen in Cardiorenal clinic
Pt had torrential tricuspid regurgitation due to CVC induced leaflet perforation ➡️ She underwent tricuspid valve replacement surgery 🫀🔪
However, 1 month after discharge she is still using a wheelchair 🤔
1/12🧵
Pt had torrential tricuspid regurgitation due to CVC induced leaflet perforation ➡️ She underwent tricuspid valve replacement surgery 🫀🔪
However, 1 month after discharge she is still using a wheelchair 🤔
1/12🧵
#POCUS above shows plethroic, non-collapsible IVC and Hepatic Veins
Did surgery work?
Is there residual tricuspid regurgitation?
#Echofist (PLAx RV view + A4ch) color Doppler lets us see there is no or minimal TR
Prosthetic valve seems to be working
2/12
Did surgery work?
Is there residual tricuspid regurgitation?
#Echofist (PLAx RV view + A4ch) color Doppler lets us see there is no or minimal TR
Prosthetic valve seems to be working
2/12
But there is still venous congestion. In fact congestion is significant, take a look at portal vein Doppler 👇
Pulsatility Fraction = 40%, this means there is significant venous congestion. Why?
Is this just volume overload? Should we probe a lower dry weight?
3/12
Pulsatility Fraction = 40%, this means there is significant venous congestion. Why?
Is this just volume overload? Should we probe a lower dry weight?
3/12
🧵Complex #Hemodynamics in ESRD:
Middle age pt ➡️ 🏥 for syncope
HPI: Low BP during HD sessions. Does not achieve dry weight. Today she has had 6 episodes of syncope!
Last episode happened as she stood up from a chair
BP 88/62, HR 87 🧠 OK, CRT 2 sec
1/8
Middle age pt ➡️ 🏥 for syncope
HPI: Low BP during HD sessions. Does not achieve dry weight. Today she has had 6 episodes of syncope!
Last episode happened as she stood up from a chair
BP 88/62, HR 87 🧠 OK, CRT 2 sec
1/8
On #Echofist you notice this👇
During systole, flow from the LV towards the Aorta should all be blue in color! (Direction away from the probe)
This apparent change in direction (red sphere) is called Aliasing
Aliasing = Very high flow Velocity!
2/8
During systole, flow from the LV towards the Aorta should all be blue in color! (Direction away from the probe)
This apparent change in direction (red sphere) is called Aliasing
Aliasing = Very high flow Velocity!
2/8
Velocity can be quantified!
Use CW Doppler passing through the red sphere 👇
Velocity = 3.8 m/s 🚨🚨🚨 This is very fast!
Whenever you see a very fast flow, think of obstruction (similar to blocking a hose with your thumb👇)
What is causing the obstruction?
3/8
Use CW Doppler passing through the red sphere 👇
Velocity = 3.8 m/s 🚨🚨🚨 This is very fast!
Whenever you see a very fast flow, think of obstruction (similar to blocking a hose with your thumb👇)
What is causing the obstruction?
3/8
