14 Sep, 4 tweets, 6 min read
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:

Why?

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# More from @GUH_ICU_Anaesth

14 Sep
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
2/13
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
3/13
a, c and possibly b!

Lets start with what TR vmax means and how it is calculated
24 Jun
1/14
GUH - Echo Tweetorial - Aortic Stenosis:

How do they calculate:
1. Valve area
2. Mean AV gradient
3. Max AV gradient
2/14
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
3/14
Continuity equation:
A2 X V2 = A1 x V1
(AVA) x (AV VTI) = (LVOT CSA) x (LVOT VTI)
AVA = [(LVOT CSA) x (LVOT VTI)]/ AV VTI
22 Jun
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:
21 Mar
1/6

LA myxoma

And for those of you who still auscultate the precordium you would have heard the elusive 'tumour plop'....of course you would.

But lets get back to the basics of M- Mode use in the PLAX view
2/6
Firstly the AV:
Here is a normal m-mode image through the AV during the cardiac cycle - note:
1. How systole and diastole are identified by ECG
2. Opening of the RCC and NCC to form the 'envelope'
3. Symmetry of the envelope
4. Closure line at end syst.
3/6
Compare this to m mode in severe AS where there is no identifiable opening of the cusps:
1 Feb
1/10
Echo Tweetorial 4 - SUBCOSTAL VIEW

1. The subcostal view
2. IVC
3. Additional subcostal views Incredibly versatile TTE view especially in ventilated patients but is trickier than it seems But first - Hand movements!
2/10
So what are we looking at:
3/10 Labelled subcostal image
26 Nov 20
1 Welcome to #researchmethodologies with @DrAoifeBee
Kaplan-Meier (KM) curves are a wonderfully informative way of presenting survival outcomes over time. But how do we interpret them? Survival analysis determines the probability of a binary outcome (aka an event or a failure)
2/15
Survival means the event being studied has not occurred yet - the patient is still alive if you’re analysing mortality, the baby has not been delivered if analysing births, the patient has not yet met whatever criteria you have decided constitutes an event in your study.
3/15
In medical research, the binary outcome of interest is commonly survival vs death though other outcomes/events can be used. KM curves are a visual way of showing the fraction of patients living over time after a treatment, or lack of treatment if in a control group.