ECHO 2013 / Management Decisions in the ICU and ER The Role of the FOCUS Echo

Differential Diagnosis PE

• Epicardial fat

• Pleural effusion

•Tumor

•Thrombus

•Ascites

Pleural Effusions

Pericardium reflects at the posterior atrioventricular groove.

Pleural effusion continues under the left atrium, posterior to the descendng aorta.

Pleural Effusions

Right

Pleural

Effusion

Left

Pleural

Effusion

Pericardial Tamponade

Hemodynamics: Comprehensive Echo

•Equilibration intracardiac diastolic pressures

usually between 10 and 30 mmHg

Within 44 mmHg

•Inspiratory increase in right-sided pressures and reduction in leftsided pressures (pulsus paradoxus)

•X - descent

descent of the base in systole

•Y - descent

occurs as the tricuspid valve opens and ventricular filling begins from the high-pressure right atrium

in constrictive pericarditis, filling is truncated in early to mid diastole

in tamponade, filling is restricted throughout diastole

•Kussmaul‟s Sign

in constriction, venous return increases with inspiration and a high right atrial pressure resists filling resulting in an increased JVP

Comprehensive Echo Imaging the

Superior Vena Cava

Subcostal View