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Focused Cardiac Ultrasound in Emergency Clinical Settings

Focused cardiac ultrasound (FoCUS) refers to a point-of-care ultrasound examination that is goal oriented in a specific clinical setting. , These “focused” bedside echocardiographic examinations differ from diagnostic echocardiography in that they are performed to answer specific clinical questions that are based on a clinically derived differential diagnosis, and they are increasingly performed by clinicians who have not necessarily achieved competency in comprehensive cardiovascular ultrasound. These…

Cardiac Point-of-Care Ultrasound: Background, Instrumentation, and Technique

When a Stat Echo is Not Fast Enough Developed for military triage, POCUS techniques easily translated to use by trauma surgeons and emergency room physicians, exemplified by the development of the Focused Abdominal Sonography for Trauma (FAST) exam in the early 1990s to diagnose traumatic intraperitoneal bleeding. Point-of-care ultrasound (POCUS) capitalizes on the immediacy and utility of ultrasound at the bedside, especially when initial triage and…

Pitfalls and Artifacts in Transesophageal Echocardiography

Acknowledgments The authors thank Drs. Stamatios Lerakis, John Palios, and Randolph P. Martin for their contributions to the previous edition of this chapter. Transesophageal echocardiography (TEE) is an invaluable tool for diagnosing and evaluating cardiac pathophysiology, and a well-performed TEE provides critical information to aid medical decision making. Therefore, it is of utmost importance that physicians recognize pitfalls and artifacts in TEE imaging that could lead…

Applications of Transesophageal Echocardiography

Transesophageal echocardiography (TEE) is a widely available imaging modality with an extensive spectrum of indications for diagnostic and intraprocedural imaging. Owing to the proximity of the TEE probe to cardiac structures and thus the improved spatial resolution, TEE offers invaluable clinical information for commonly encountered cardiac diseases, with guideline-based recommendations for its use spanning from: assessment of mechanism and severity of native and prosthetic valvular disease,…

Transesophageal Echocardiography Tomographic Views

Transesophageal echocardiography (TEE) has proven utility in a number of clinical scenarios, including the operating room, intensive care unit, and outpatient setting. The rapid growth of structural heart disease interventions has led to a greater appreciation of the role of TEE in both disease diagnosis as well as procedural guidance. Thus, TEE has become an essential interdisciplinary imaging tool for cardiac surgeons, anesthesiologists, cardiac interventionalists, and…

Introduction to Transesophageal Echocardiography: Indications, Risks, Complications, and Protocol

Acknowledgment The author would like to acknowledge the contributions of Drs. Elyse Foster and Atif Qasim, who were the authors of this chapter in previous edition. The field of transesophageal echocardiography (TEE) has evolved significantly since its initial development. The esophageal transducer was developed to obtain ultrasound images from the esophagus, an ideal location because of its direct location behind the heart and associated structures. This…

Doppler Echocardiography: Normal Antegrade Flow Patterns

Basic Concepts Four modalities of Doppler echocardiography are currently available for use with a wide variety of applications: pulsed-wave (PW) Doppler, continuous-wave (CW) Doppler, color-flow imaging, and tissue Doppler imaging. The various Doppler modalities each complement M-mode and two-dimensional (2D) or three-dimensional (3D) B-mode structural data with hemodynamic (CW and PW Doppler and color-flow Doppler) and functional (tissue Doppler imaging) data. Doppler echocardiography is the modality…

M-Mode Echocardiography

Historically, M-mode (motion mode) echocardiography was the first effective modality for the ultrasonic evaluation of the heart. M-mode echocardiography provides an ice pick, one-dimensional (1D; depth only) view of the heart. , The ultrasound echoes reflected from the various cardiac interfaces are represented as dots and their intensities by brightness (B-mode). With the sweep of the screen (or the recording paper), the location of each interface…

Transthoracic Echocardiography Tomographic Views

This chapter describes the main set of echocardiographic images that should be obtained for standardization and facilitation of image interpretation. Standard examination images are acquired from several transducer positions on the chest wall. Each window, angulation, and rotation of the transducer about its axis enables acquisition of several tomographic echocardiographic views. The sonographer acquiring the images may sit on either the left side of the patient,…

Technical Quality and Tips

Acknowledgment The authors acknowledge the valuable input and suggestions offered by Dr. Andy Pellett, PhD, RDCS, who reviewed this chapter. Optimizing Two-Dimensional Images The most commonly used controls for optimizing two-dimensional (2D) images are summarized in Table 8.1 . These controls can be used to improve spatial, contrast, and temporal resolution. Spatial resolution refers to the ability of the ultrasound machine to detect structures that are…

Transthoracic Echocardiography: Nomenclature and Standard Views

Imaging Planes The imaging planes are the long-axis (images acquired in the parasternal long-axis [PLAX] views), short-axis (images acquired in the parasternal short-axis [PSAX] views), and apical (images acquired in the apical views) planes ( Fig. 7.1 ). You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Clinical Utility of Global Longitudinal Strain

In the past two decades, two-dimensional speckle-tracking global longitudinal strain (GLS) has become one of the most important new echocardiographic parameters for the assessment of cardiac diseases. Indeed, it has been widely demonstrated that GLS provides reliable and early information regarding the diagnosis and prognosis in several clinical settings, and it is more practical than conventional parameters such as left ventricular ejection fraction (LVEF) because it…

Speckle-Tracking and Strain Measurements: Principles, Techniques, and Limitations

General Concepts The word “strain,” which in everyday language means “stretching,” in echocardiography indicates a measure of tissue deformation; the “strain rate” is the rate at which the deformation occurs. Considering a given one-dimensional object under either lengthening or shortening deformation, the initial length could be indicated as L 0 and its length at a given time as L ( t ). The normalized deformation, strain…

Tissue Doppler, Myocardial Work: Physics and Techniques

Tissue Doppler Imaging Doppler shifts within the heart return either from moving red blood cells or moving myocardial tissue. Blood flow is high velocity; therefore, pulsed-wave Doppler assessment requires backscatter of high velocities and low amplitudes. In comparison, tissue Doppler imaging (TDI) focuses on myocardial velocities at specific locations within the heart that are much slower and amplitudes that are much higher. Distinction between Doppler signals…

Doppler Principles

Echocardiography provides noninvasive, real-time, diagnostic cardiac anatomic imaging (see Chapter 1 ) and motion and flow information. In the present context, the motion and flow are myocardial motion of contraction and relaxation and the resulting flow of blood, respectively. Motion and flow information are provided by implementing the Doppler effect. Doppler Effect The Doppler effect is a change in frequency caused by motion of a sound…

Three-Dimensional Echocardiography

The milestone in the history of three-dimensional echocardiography (3DE) has been the development of fully sampled matrix-array transthoracic transducers based on advanced digital processing and improved image formation algorithms that allowed the operators to obtain on-cart transthoracic real-time volumetric imaging with short acquisition times and high spatial and temporal resolution. Further technological developments (i.e., advances in miniaturization of the electronics and in element interconnection technology) made…

General Principles of Echocardiography

Echocardiography is diagnostic imaging with ultrasound (sonography) of the heart. Sonography comes from the Latin sonus (sound) and the Greek graphein (to write). Diagnostic sonography is medical, real-time, two-dimensional (2D) and three-dimensional (3D) anatomic, motion, and flow imaging using ultrasound. Ultrasound Ultrasound is sound, a traveling pressure wave, of frequency higher than what humans can hear. Frequencies used in echocardiography range from about 2 MHz for…