Echo - EM Guidelines

Cardiology‎ > ‎

Echo

www.echopedia.org

Yale Atlas: http://www.yale.edu/imaging/echo_atlas/views/index.html

Stanford Echo: http://www.stanford.edu/group/ccm_echocardio/cgi-bin/mediawiki/index.php/Main_Page

Pressure gradient (dP) (mmHg) = 4v² (m/s)

Mean PA pressure = 0.61 × PASP + 2

Stroke volume = VTI_LVOT x Area_LVOT

LAP = SBP - dP_LA/LV (MR jet)

Pulmonary hypertension = High TR max velocity (≥ 2.6 m/s) or low PA acceleration time (<105)

Pressure (chronic) overload = D-shaped septum in systole

Volume overload = D-shaped septum in diastole

EF ≈ 20 + 44(aortic root displacement [cm]) (Acad EM 2013; 20:367-373)

Reference limits and values and partition values of left ventricular function

	Women				Men
	Reference range	Mildly abnormal	Moderately abnormal	Severely abnormal	Reference range	Mildly abnormal	Moderately abnormal	Severely abnormal
Linear method
Endocardial fractional shrt'ng, %	27–45	22–26	17–21	≤16	25–43	20–24	15–19	≤14
Midwall fractional shortening, %	15–23	13–14	11–12	≤10	14–22	12–13	10–11	≤10
2D Method
Ejection fraction, %	≥55	45–54	30–44	<30	≥55	45–54	30–44	<30

Eur J Echocardiogr 2006 Mar; 7(2) 79-108.

Estimation of right atrial pressure from the inferior vena cava (spontaneously breathing)

Inferior vena cava diameter	Change with respiration	Estimated right atrial pressure mmHg
Small <1.5 cm	Collapse	0
Normal 1.5–2.5 cm	Decrease by >50%	5
Normal	Decrease by <50%	10
Dilated >2.5 cm	Decrease by <50%	15
Dilated with dilated hepatic veins	No change	20

Am J. Cardiol. 1990;66: 493-6

Estimation of CVP from the IVC (mechanically ventilated)

Diastology:

Lusitropy = myocardial relaxation

Increased with catecholamines

Decreased with extracellular calcium

Emergency Ultrasound Podcast:

Diastology I http://www.youtube.com/watch?v=N5UUeUMAZsM

Diastology II http://www.youtube.com/watch?v=opaeJFU-TQ4

Mitral Valve Inflow (MVI)

Normal: E > A

Impaired Relaxation: E < A

Pseudonormal: E > A

Restrictive: E >> A

Mitral Annulus Tissue Doppler (TDI)

Normal: e' > a'

Normal: e' > 8

Nagueh-Formula: 1.9 + (1.24 x E/E') = PCWP

Echo Curriculum Videos:

Part I - Principles of Ultrasound (4:54)

https://www.dropbox.com/s/am24m57ldgyq97k/Part%20I%20-%20Principles%20of%20Ultasound.wmv

Part II - Basic Views (4:44)

https://www.dropbox.com/s/qrq70qpya6yw8an/Part%20II%20-%20Basic%20Views.wmv

Part III - Doppler and Valves (4:46)

https://www.dropbox.com/s/4jhqdd8f8h2zqgo/Part%20III%20-%20Doppler%20and%20Valves.wmv

Part IV - Functional Assessment (5:18)

https://www.dropbox.com/s/v1v4krioyndtx5j/Part%20IV%20-%20Functional%20Assessment.wmv

Additional resources:

Principles of Ultrasound:

http://folk.ntnu.no/stoylen/strainrate/Ultrasound/#Imaging

Basic Views:

http://www.echopedia.org/wiki/Standard_imaging_Views

Doppler and Valves:

http://www.echopedia.org/wiki/Normal_Values_of_TTE

Stroke Volume and EF:

http://www.criticalecho.com/content/tutorial-5-assessment-lv-systolic-function

Diastolic function:

http://www.echocardiology.org/diastolicfunction.htm

http://www.echobasics.de/diastole-en.html

Selection	File type icon	File name	Description	Size	Revision	Time	User
	Ċ	View Download		808k	v. 1	Jan 19, 2014, 2:59 PM	Kit Tainter
	Ċ	View Download		1179k	v. 1	Jan 19, 2014, 2:59 PM	Kit Tainter
	Ċ	View Download		1685k	v. 1	Jul 24, 2015, 3:43 PM	Kit Tainter
	Ċ	View Download		1133k	v. 1	Nov 10, 2017, 9:26 AM	Kit Tainter
	ą	View Download		217k	v. 1	Oct 7, 2013, 7:08 AM	Kit Tainter
	Ċ	View Download		1408k	v. 1	Jun 2, 2013, 8:37 AM	Kit Tainter
	Ċ	View Download		630k	v. 1	Dec 26, 2014, 7:13 AM	Kit Tainter
	Ċ	View Download		870k	v. 1	Jul 21, 2014, 9:27 AM	Kit Tainter
	ą	View Download		28k	v. 1	Apr 11, 2016, 2:26 PM	Kit Tainter
	Ċ	View Download		390k	v. 1	Jan 30, 2014, 8:52 AM	Kit Tainter
	Ċ	View Download		1175k	v. 1	Apr 27, 2015, 3:50 PM	Kit Tainter
	Ċ	View Download		2802k	v. 1	Jan 14, 2019, 3:57 PM	Kit Tainter

Comments