Unilateral cardiogenic pulmonary edema (CPE) accounts for ~2% of pulmonary edema cases and is classically caused by posterior papillary muscle rupture, resulting in acute, severe, eccentric mitral regurgitation. Flow is directed specifically to the right-sided pulmonary veins. This, in turn, overwhelms the lymphatic capacity of the right lung and results…
The normal aortic valve is trileaflet and comprised of the non, left, and right coronary cusps. Quadricuspid aortic valve (QAV) is an extremely rare malformation occurring in only 0.008% of autopsies and 0.043% of cases examined through echocardiography. Hurwitz and Roberts proposed seven classes of QAV based on the arrangement…
Aortic dissection is a life-threatening condition characterized by a tear in the innermost layer of the aorta (tunica intima), permitting blood to enter and separate the intima from the aorta’s middle layer (tunica media). This event creates a false lumen (FL) alongside the true lumen (TL) of the aorta. Typically,…
Concentric left ventricular hypertrophy (LVH) is characterized by adaptive thickening of the myocardium in response to pressure overload from chronic hypertension or aortic valve stenosis. LVH can also be seen in genetic conditions like Fabry disease or hypertrophic cardiomyopathy with chaotic sarcomeric disarray at the cellular level. LVH leads to…
Intraabdominal hypertension (IAH) and abdominal compartment syndrome are defined as sustained intraabdominal pressure (IAP) ≥ 12 mmHg and > 20 mmHg with new organ dysfunction, respectively. This can be challenging to diagnose in patients who are pregnant, obese, or with ascites. Bladder pressure from a Foley catheter can be used…
Pulmonary velocity acceleration time (PVAT), measured in milliseconds (ms), can be used to estimate pulmonary artery pressure (PAP) when a tricuspid regurgitation jet is difficult to locate or cannot be accurately interrogated with Doppler. In this parasternal short-axis transthoracic echo view directed anteriorly and to the patient’s right, pulsed-wave Doppler…
Point-of-care ultrasound (POCUS) can be extremely helpful during advanced cardiovascular life support (ACLS) with ongoing chest compressions and resuscitation. POCUS can help rule in or out certain etiologies (the H’s and T’s) for why a patient arrested. During the pulse check, I record the clearest subcostal 4 or 5 chamber…
The traditional way of assessing the inferior vena cava (IVC) with point-of-care ultrasound (POCUS) is longitudinally from a subcostal window; however, this can be challenging when that area is off limits (subcostal chest tubes, burn injuries, etc.) The transhepatic IVC view is obtained by placing a phased array probe (oriented…
Left ventricular (LV) dilation can stretch apart the mitral valve annulus causing the chordae tendinae to be pulled taut (particularly to the posterior leaflet). This restricts leaflet motion (Carpentier type III) over the cardiac cycle causing malcoaptation and associated mitral regurgitation (MR). Classically, with type III MR, the regurgitation jet…
Surgical septal myectomy is a procedure typically done for hypertrophic cardiomyopathy (HCM) where a portion of the hypertrophied interventricular septum (IVS) is resected. The basal portion of the IVS can lead to left ventricular outflow tract obstruction (LVOTO), limiting cardiac output and causing associated symptoms like dyspnea, lethargy, and organ…