ED visit for unrelated issue, incidentally I found a murmur which the patient was unaware of...#POCUS
These high pressure muscular VSD’s have no hemodynamic consequence but can cause endocarditis Image
Modified Short Axis view

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More from @DrShukla14

25 Nov
Thread, 1/n - Male 75. Acute dyspnea since 1 hour, can't talk, wheezy. SPO2 75%. No previous record. "All that wheezes is not asthma". #POCUS leaves no doubt about pulmonary edema, Dx while patient is being attached to monitor.BP 180/110 mmHg.
2/n CPAP 10 mmHg, IV infusion of nitrate being prepared. Pectus excavatum, parasternal long axis impossible from usual 3/4 ICS. But Apical 4 chamber suggests mild LV systolic dysfunction
3/n As I was about to bolus nitrate 500 mcg - BP drops from 180/110 to 120/70 mmHg. Patient improving with CPAP. So I hold the bolus and try to get more cardiac views. Patient upright plus pectus excavatum, thus not the best quality, but aortic valve appears calcific.
Read 6 tweets
11 Dec 20
1/n #POCUS is more sensitive than CXR for subtle consolidation detection. M/40, fever, right sided chest pain. Had cough 3 d ago, now resolved.WCC 13k, CRP 230. Normal physical exam.
2/n #POCUS showed bilateral small basal consolidations, B-lines at right base with sub pleural consolidations. Right posterior basal region sub pleural consolidation -
3/n B-lines right base
Read 6 tweets
8 Nov 20
1/n #POCUS findings of effusive constrictive pericarditis. Patient presented with 2 months progressive pedal edema and ascites. Pericardial effusion, funny bounce of IVS
2/n A4C septal bounce
3/n Plethoric IVC
Read 9 tweets
26 Oct 20
1/n #POCUS as a part of ED evaluation for first episode of atrial fibrillation (this demographic has significant prevalence of rheumatic heart disease) - appears grossly normal - moving on to other views...
2/n Apical 4C also grossly normal....
2/n but as probe swept caudally from A4C .. what’s that in RA?
Read 6 tweets
5 Oct 20
1/n #POCUS M/68, vomiting since 6 hours, back pain since 1 h. Says no to chest pain /abd pain / dyspnea. Diaphoretic, vomiting, HR 90, RR 24, BP 128/70, SpO2 91% (air). Reduced BS left side, Abd distended, nontender. ECG normal. Is it acute aortic? Tried to get PLAX heart -
2/n - scanning right parasternal area - found the heart - hyperdynamic, but nothing grossly wrong there.
3/n #POCUS Another look at left hemithorax anteriorly (parasaggital plane, mid-clavicular line, 4th. ICS)
Read 9 tweets
30 Sep 20
Thread 1/4 - #POCUS Case - MPA+bilateral PE. HR 110, BP 94/68, Sats 98% room air. Subjectively, patient feels well, no dyspnea/pain. Warm skin. Shifted to EM Resus. Lytic or not? Young pt, no known co-morbids / provocation.
2/4 #POCUS - RV does not seem dilated
3/4 #POCUS - IVC seems collapsed
Read 5 tweets

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